Provider Demographics
NPI:1861219537
Name:HODGES, DYNISHA GWENDOLYN (MPSS, SUDRC)
Entity type:Individual
Prefix:
First Name:DYNISHA
Middle Name:GWENDOLYN
Last Name:HODGES
Suffix:
Gender:F
Credentials:MPSS, SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MARINA BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-2102
Mailing Address - Country:US
Mailing Address - Phone:925-427-9100
Mailing Address - Fax:
Practice Address - Street 1:535 MARINA BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-2102
Practice Address - Country:US
Practice Address - Phone:925-427-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16193101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)