Provider Demographics
NPI:1801395702
Name:HUGHES, RODERICK THEODORE III (RBT)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:THEODORE
Last Name:HUGHES
Suffix:III
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12786 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-2698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12786 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:ELBERTA
Practice Address - State:AL
Practice Address - Zip Code:36530-2698
Practice Address - Country:US
Practice Address - Phone:251-228-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician