Provider Demographics
NPI:1871298596
Name:HODGE, VICTORIA GRACE (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
Last Name:HODGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:MI
Mailing Address - Zip Code:48612-9777
Mailing Address - Country:US
Mailing Address - Phone:248-978-3596
Mailing Address - Fax:
Practice Address - Street 1:440 S ROSS ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:MI
Practice Address - Zip Code:48612-9101
Practice Address - Country:US
Practice Address - Phone:989-246-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011152381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical