Healthcare Provider Details

I. General information

NPI: 1598529703
Provider Name (Legal Business Name): STACY JOI WASHINGTON-HODGES BCBA, LBA, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 HIGHWAY 178
OLIVE BRANCH MS
38654-8751
US

IV. Provider business mailing address

11109 HIGHWAY 178
OLIVE BRANCH MS
38654-8751
US

V. Phone/Fax

Practice location:
  • Phone: 662-924-2686
  • Fax: 901-677-1681
Mailing address:
  • Phone: 662-924-2686
  • Fax: 901-677-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1461
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: