Healthcare Provider Details

I. General information

NPI: 1285124099
Provider Name (Legal Business Name): MARIAH SOMMER HODGE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAH SOMMER HODGE BCBA

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6752 U S HIGHWAY 98
HATTIESBURG MS
39402-8443
US

IV. Provider business mailing address

19 HILLTOP DR
LAUREL MS
39443-0979
US

V. Phone/Fax

Practice location:
  • Phone: 601-721-0080
  • Fax:
Mailing address:
  • Phone: 601-470-7128
  • Fax: 601-470-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58133
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-55442
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: