Provider Demographics
NPI:1558790048
Name:HODGDON, DEBORAH (BCBA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HODGDON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:CAWSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 MARKET LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4547
Mailing Address - Country:US
Mailing Address - Phone:571-379-0345
Mailing Address - Fax:
Practice Address - Street 1:128 MARKET LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4547
Practice Address - Country:US
Practice Address - Phone:571-379-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1-13-15045103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst