Provider Demographics
NPI:1538841507
Name:BODIFORD, AUDREY MICHELLE (BS)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:MICHELLE
Last Name:BODIFORD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD STE 189
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0434
Mailing Address - Country:US
Mailing Address - Phone:517-272-4357
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 189
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0434
Practice Address - Country:US
Practice Address - Phone:517-272-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)