Provider Demographics
NPI:1730686155
Name:HODGES, WILLIE F IV (QBHS)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:F
Last Name:HODGES
Suffix:IV
Gender:M
Credentials:QBHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 E DERBYSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2729
Mailing Address - Country:US
Mailing Address - Phone:941-413-9517
Mailing Address - Fax:
Practice Address - Street 1:30800 CHARGIN BOULEVARD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:216-591-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker