Provider Demographics
NPI:1326386368
Name:DODD, JASON (LCDCI)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DODD
Suffix:
Gender:M
Credentials:LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MANN ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-2046
Mailing Address - Country:US
Mailing Address - Phone:361-814-2001
Mailing Address - Fax:361-883-1998
Practice Address - Street 1:400 MANN ST
Practice Address - Street 2:SUITE 800
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2046
Practice Address - Country:US
Practice Address - Phone:361-814-2001
Practice Address - Fax:361-883-1998
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16965101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)