Provider Demographics
NPI:1558015156
Name:BODOE, ALEENA (DMFT)
Entity Type:Individual
Prefix:
First Name:ALEENA
Middle Name:
Last Name:BODOE
Suffix:
Gender:F
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 KNIGHT BOXX RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7395
Mailing Address - Country:US
Mailing Address - Phone:904-379-8675
Mailing Address - Fax:
Practice Address - Street 1:8465 MERCHANTS WAY STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2858
Practice Address - Country:US
Practice Address - Phone:904-379-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist