Provider Demographics
NPI:1538387097
Name:MINTER, JUDITH HOGE (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:HOGE
Last Name:MINTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST SOUTH ST
Mailing Address - Street 2:STE 5
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5217
Mailing Address - Country:US
Mailing Address - Phone:434-971-4747
Mailing Address - Fax:434-293-4690
Practice Address - Street 1:100 EAST SOUTH ST
Practice Address - Street 2:STE 5
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5217
Practice Address - Country:US
Practice Address - Phone:434-971-4747
Practice Address - Fax:434-293-4690
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001192104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA249190OtherANTHEM INS