Provider Demographics
NPI:1598529703
Name:WASHINGTON-HODGES, STACY JOI (BCBA, LBA, MA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JOI
Last Name:WASHINGTON-HODGES
Suffix:
Gender:F
Credentials:BCBA, LBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 SUMMER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2883
Mailing Address - Country:US
Mailing Address - Phone:901-425-5821
Mailing Address - Fax:
Practice Address - Street 1:2785 SUMMER OAKS DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2883
Practice Address - Country:US
Practice Address - Phone:901-425-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1461103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst