Provider Demographics
NPI:1750449385
Name:DODENHOFF, JOHN RAMSEY (LISW-CP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RAMSEY
Last Name:DODENHOFF
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MEMORIAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4407
Mailing Address - Country:US
Mailing Address - Phone:864-295-2221
Mailing Address - Fax:864-220-6109
Practice Address - Street 1:27 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4407
Practice Address - Country:US
Practice Address - Phone:864-295-2221
Practice Address - Fax:864-220-6109
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0734Medicaid
SCQ33197Medicare UPIN