Provider Demographics
NPI:1134635295
Name:DODD, AMANDA LEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEE
Last Name:DODD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:WAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5119 SPRING ASH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1827
Mailing Address - Country:US
Mailing Address - Phone:856-371-9086
Mailing Address - Fax:
Practice Address - Street 1:5119 SPRING ASH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1827
Practice Address - Country:US
Practice Address - Phone:856-371-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040101731041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical