Provider Demographics
NPI:1497105662
Name:DODSON, SUZANNE (LPC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:DODSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SUZY
Other - Middle Name:
Other - Last Name:SNEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:446 MEATHWARD CIR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9028
Mailing Address - Country:US
Mailing Address - Phone:864-982-3963
Mailing Address - Fax:
Practice Address - Street 1:561 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1946
Practice Address - Country:US
Practice Address - Phone:864-982-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2000Medicaid