Provider Demographics
NPI:1427289024
Name:DODSON, CYNTHIA L (MS, CSAC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:DODSON
Suffix:
Gender:F
Credentials:MS, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1263 KUANOO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4640
Mailing Address - Country:US
Mailing Address - Phone:301-452-7702
Mailing Address - Fax:
Practice Address - Street 1:TRIPLER ARMY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96859-5000
Practice Address - Country:US
Practice Address - Phone:808-433-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1420-09101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN