Provider Demographics
NPI:1730119942
Name:HODGE, ELAINE ARENA (EDD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:ARENA
Last Name:HODGE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 HUMMINGBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5737
Mailing Address - Country:US
Mailing Address - Phone:928-717-0064
Mailing Address - Fax:928-717-0064
Practice Address - Street 1:211 GROVE AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5737
Practice Address - Country:US
Practice Address - Phone:928-848-0666
Practice Address - Fax:928-717-0064
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical