Provider Demographics
NPI:1437646312
Name:NOLES, DODIE R (CADC 1)
Entity Type:Individual
Prefix:
First Name:DODIE
Middle Name:R
Last Name:NOLES
Suffix:
Gender:F
Credentials:CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E HERSEY ST STE 8
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1200
Mailing Address - Country:US
Mailing Address - Phone:541-944-1247
Mailing Address - Fax:541-488-7721
Practice Address - Street 1:607 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2139
Practice Address - Country:US
Practice Address - Phone:541-944-1247
Practice Address - Fax:541-488-7721
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18-03-20101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)