Provider Demographics
NPI:1366898496
Name:HODGES, EDDRICK
Entity type:Individual
Prefix:
First Name:EDDRICK
Middle Name:
Last Name:HODGES
Suffix:
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 1:12901 JEFFERSON HWY
Mailing Address - Street 2:APT 225
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6300
Mailing Address - Country:US
Mailing Address - Phone:225-328-7869
Mailing Address - Fax:
Practice Address - Street 1:12901 JEFFERSON HWY
Practice Address - Street 2:APT 225
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6300
Practice Address - Country:US
Practice Address - Phone:225-328-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health