Provider Demographics
NPI:1548863756
Name:STOKES, D'LICIA ROCHELLE
Entity type:Individual
Prefix:
First Name:D'LICIA
Middle Name:ROCHELLE
Last Name:STOKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 PEPPER TREE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4408
Mailing Address - Country:US
Mailing Address - Phone:937-999-7871
Mailing Address - Fax:
Practice Address - Street 1:10 COFFMAN AVE
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2802
Practice Address - Country:US
Practice Address - Phone:937-529-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5706570Medicaid