Provider Demographics
NPI:1336753672
Name:ANDREW B. DODSON, PHD LLC
Entity type:Organization
Organization Name:ANDREW B. DODSON, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:318-348-6776
Mailing Address - Street 1:203 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2503
Mailing Address - Country:US
Mailing Address - Phone:318-348-6776
Mailing Address - Fax:
Practice Address - Street 1:3201 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-2229
Practice Address - Country:US
Practice Address - Phone:318-396-8152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty