Healthcare Provider Details

I. General information

NPI: 1942867080
Provider Name (Legal Business Name): LISA MARIE HODGES LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA MARIE MARION

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 QUEEN RD
CANDLER NC
28715-9257
US

IV. Provider business mailing address

91 TIMBERLANE RD
WAYNESVILLE NC
28786-7927
US

V. Phone/Fax

Practice location:
  • Phone: 424-202-4739
  • Fax:
Mailing address:
  • Phone: 828-837-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA14722
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: