Provider Demographics
NPI:1619120417
Name:DODGE, SANDRA L (LCMHC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:DODGE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-3919
Mailing Address - Country:US
Mailing Address - Phone:603-767-3043
Mailing Address - Fax:603-379-2529
Practice Address - Street 1:367 ROUTE 9
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-3919
Practice Address - Country:US
Practice Address - Phone:603-767-3043
Practice Address - Fax:603-379-2529
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health