Provider Demographics
NPI:1467943654
Name:DODD, CHARLOTTE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELIZABETH
Last Name:DODD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:ELLIZABETH
Other - Last Name:ALLMAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2350 WASHTENAW AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4526
Mailing Address - Country:US
Mailing Address - Phone:734-730-7348
Mailing Address - Fax:
Practice Address - Street 1:2350 WASHTENAW AVE STE 3
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4526
Practice Address - Country:US
Practice Address - Phone:173-473-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014778103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301014778OtherLLP