Healthcare Provider Details

I. General information

NPI: 1356282024
Provider Name (Legal Business Name): MARCELLINA HODGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 CYNTHIA PL
RALEIGH NC
27610-3534
US

IV. Provider business mailing address

1804 CYNTHIA PL
RALEIGH NC
27610-3534
US

V. Phone/Fax

Practice location:
  • Phone: 919-594-9012
  • Fax:
Mailing address:
  • Phone: 919-594-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number33428
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: