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General NPI Number Information
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NPI Number | 1265240311
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Entity Type | Individual
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Provider Name | SHANNON MARIE HODGES CSAC-S
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1345 PLANTATION RD NE
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City | ROANOKE
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State | VA
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Zip | 24012-5712
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Country | US
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Telephone | 866-934-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 388 OCALA RD
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City | GLADE HILL
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State | VA
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Zip | 24092-3631
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Country | US
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Telephone | 540-352-0395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0709026634
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License Number State | VA
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