Provider Demographics
NPI:1487109989
Name:DODSON, REGINA (BSSW, CSW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:DODSON
Suffix:
Gender:F
Credentials:BSSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BROKEN WHEEL CT
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1673
Mailing Address - Country:US
Mailing Address - Phone:307-421-0834
Mailing Address - Fax:
Practice Address - Street 1:611 BROKEN WHEEL CT
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-1673
Practice Address - Country:US
Practice Address - Phone:307-421-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical