Provider Demographics
NPI:1073251823
Name:HODGE, DESTINY LYNN
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:LYNN
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4117
Mailing Address - Country:US
Mailing Address - Phone:513-849-2081
Mailing Address - Fax:513-849-2071
Practice Address - Street 1:1215 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4117
Practice Address - Country:US
Practice Address - Phone:513-849-2081
Practice Address - Fax:513-849-2071
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)