Provider Demographics
NPI:1861258444
Name:HODGES-PIETRYKA PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:HODGES-PIETRYKA PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES-PIETRYKA
Authorized Official - Suffix:
Authorized Official - Credentials:LP, PSYD
Authorized Official - Phone:248-533-0814
Mailing Address - Street 1:18625 INNSBROOK DR APT 2
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18625 INNSBROOK DR APT 2
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-2428
Practice Address - Country:US
Practice Address - Phone:248-553-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty