Provider Demographics
NPI:1326303207
Name:HODGES, DOUGLAS T (MS)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:T
Last Name:HODGES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10125 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4209
Mailing Address - Country:US
Mailing Address - Phone:407-753-7441
Mailing Address - Fax:
Practice Address - Street 1:10125 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4209
Practice Address - Country:US
Practice Address - Phone:407-753-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6060101YM0800X
FLMH12517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health