Provider Demographics
NPI:1962782920
Name:DODGENS, SARA SANDERSON (LCAS, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:SANDERSON
Last Name:DODGENS
Suffix:
Gender:F
Credentials:LCAS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 PINEY WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-4212
Mailing Address - Country:US
Mailing Address - Phone:910-604-1637
Mailing Address - Fax:
Practice Address - Street 1:786 PINEY WOODS RD
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-4212
Practice Address - Country:US
Practice Address - Phone:910-604-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0074981041C0700X
NC1415101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)