Provider Demographics
NPI:1467092189
Name:DODSON, KALEIGH (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:DODSON
Suffix:
Gender:F
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 1:1317 RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3523
Mailing Address - Country:US
Mailing Address - Phone:903-277-0282
Mailing Address - Fax:
Practice Address - Street 1:1317 RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3523
Practice Address - Country:US
Practice Address - Phone:903-277-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75465103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling