Individual
MR. BRYAN W HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW, LADAC
Contact information
Practice address
100 W GRIGGS AVE, LAS CRUCES, NM 88001-1234
(575) 647-2800
(575) 647-2898
Mailing address
100 W GRIGGS AVE, LAS CRUCES, NM 88001-1234
(575) 647-2800
(575) 647-2898
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0081351
NM
1041C0700X
Clinical Social Worker
Primary
I-05676
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
Enumeration date
04/19/2007
Last updated
02/17/2015
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