Provider Demographics
NPI:1477708303
Name:DODGE, DEBORAH H (LCPC-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:H
Last Name:DODGE
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 339A
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-9737
Mailing Address - Country:US
Mailing Address - Phone:207-255-8199
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 339A
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-9737
Practice Address - Country:US
Practice Address - Phone:207-255-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME412260099Medicaid