Healthcare Provider Details

I. General information

NPI: 1578059671
Provider Name (Legal Business Name): YOLANDA YVONNE HODGES CAC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 N ACADEMY BLVD STE 290
COLORADO SPRINGS CO
80918-4038
US

IV. Provider business mailing address

5360 N ACADEMY BLVD STE 290
COLORADO SPRINGS CO
80918-4038
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-2061
  • Fax: 719-434-2275
Mailing address:
  • Phone: 719-434-2061
  • Fax: 719-434-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0004402
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: