Provider Demographics
NPI:1033632583
Name:HODNETT, JUSTIN (LMFT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HODNETT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 E ROSEVILLE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7981
Mailing Address - Country:US
Mailing Address - Phone:916-480-5101
Mailing Address - Fax:
Practice Address - Street 1:1899 E ROSEVILLE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7981
Practice Address - Country:US
Practice Address - Phone:916-480-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA124043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)