Provider Demographics
NPI:1235786187
Name:DODSON, ANDREW RICHARD (MED, LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:RICHARD
Last Name:DODSON
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 VINCENT RD
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2947
Mailing Address - Country:US
Mailing Address - Phone:330-962-0129
Mailing Address - Fax:
Practice Address - Street 1:919 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1132
Practice Address - Country:US
Practice Address - Phone:330-454-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901981101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor