Basic Information
| Provider Information | |||||||||
| NPI: | 1114155025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODIAK | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | GRACE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW, LEAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 DRAGON FLY CT | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283876476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106924629 | ||||||||
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| Practice Location | |||||||||
| Address1: | WOMACK ARMY MEDICAL CTR | ||||||||
| Address2: | 2817 REILLY ROAD | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109076246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 06/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C002780 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.