Individual
GWEN L HODRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
660 ACOMA BLVD N, LAKE HAVASU CITY, AZ 86403-3662
(214) 702-6775
(214) 614-4725
Mailing address
660 ACOMA BLVD N, LAKE HAVASU CITY, AZ 86403-3662
(214) 914-6775
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12811
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20753
AZ
101YP2500X
Professional Counselor
69392
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164381
—
AZ
Enumeration date
06/04/2015
Last updated
09/28/2022
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