Basic Information
| Provider Information | |||||||||
| NPI: | 1801949615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGES | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | BS LCDC NCAC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3031 W IH 10 | ||||||||
| Address2: | THE CENTER FOR HEALTH CARE SERVICES | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782015159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107311320 | ||||||||
| FaxNumber: | 2107319661 | ||||||||
| Practice Location | |||||||||
| Address1: | 3031 W IH 10 | ||||||||
| Address2: | THE CENTER FOR HEALTH CARE SERVICES | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782015159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107311320 | ||||||||
| FaxNumber: | 2107319661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 02/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 10978 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.