Provider Demographics
NPI:1629599337
Name:HODDER-SHIPP, NATHANIEL (CADC)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:HODDER-SHIPP
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 ALMA REAL DR STE 310
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-5009
Mailing Address - Country:US
Mailing Address - Phone:310-310-9249
Mailing Address - Fax:
Practice Address - Street 1:881 ALMA REAL DRIVE
Practice Address - Street 2:#310
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272
Practice Address - Country:US
Practice Address - Phone:310-310-9249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)