Provider Demographics
NPI:1891463212
Name:HODGES-MILLS, RAJONTA (LCADC)
Entity type:Individual
Prefix:
First Name:RAJONTA
Middle Name:
Last Name:HODGES-MILLS
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MARTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1119
Mailing Address - Country:US
Mailing Address - Phone:609-218-8768
Mailing Address - Fax:
Practice Address - Street 1:29 MARTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-1119
Practice Address - Country:US
Practice Address - Phone:609-218-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00334200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty