Provider Demographics
NPI:1770203234
Name:HODGES, PACIES ADOKA (CSAC)
Entity type:Individual
Prefix:
First Name:PACIES
Middle Name:ADOKA
Last Name:HODGES
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 TRAFALGAR ARCH
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1659
Mailing Address - Country:US
Mailing Address - Phone:757-532-0705
Mailing Address - Fax:
Practice Address - Street 1:5638 TRAFALGAR ARCH
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-1659
Practice Address - Country:US
Practice Address - Phone:757-532-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103659101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000000000OtherPRIVATE PAY