Provider Demographics
NPI:1164692497
Name:DODSON, MICHAEL GENE (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GENE
Last Name:DODSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 VERANDA LANE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-4907
Mailing Address - Country:US
Mailing Address - Phone:803-640-7463
Mailing Address - Fax:
Practice Address - Street 1:145 VERANDA LANE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-4907
Practice Address - Country:US
Practice Address - Phone:803-640-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMRW146103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral