Individual
MARY HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2311 WOODBRIDGE ST, ROSEVILLE, MN 55113-4710
(651) 773-0832
(651) 773-9115
Mailing address
2311 WOODBRIDGE ST, ROSEVILLE, MN 55113-4710
(651) 773-0832
(651) 773-9115
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303575
MN
Other
Enumeration date
12/14/2017
Last updated
12/14/2017
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