Provider Demographics
NPI:1699917906
Name:HODGES, ANTOINETTE M (BA, MHPP)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:M
Last Name:HODGES
Suffix:
Gender:F
Credentials:BA, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15968
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5968
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:1109 BURMAN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4386
Practice Address - Country:US
Practice Address - Phone:501-982-7515
Practice Address - Fax:501-982-7510
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator