Provider Demographics
NPI:1306590757
Name:HODGES, DEMETRIUS BENARD SR
Entity type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:BENARD
Last Name:HODGES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3991 MYRON AVE
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1548
Mailing Address - Country:US
Mailing Address - Phone:937-931-6155
Mailing Address - Fax:
Practice Address - Street 1:5 STUCKHARDT RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2756
Practice Address - Country:US
Practice Address - Phone:937-931-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician