Provider Demographics
NPI:1861636201
Name:DODDS, AL GREGORY (LPC)
Entity Type:Individual
Prefix:
First Name:AL
Middle Name:GREGORY
Last Name:DODDS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7300
Mailing Address - Country:US
Mailing Address - Phone:678-565-0400
Mailing Address - Fax:678-565-0444
Practice Address - Street 1:277 NORTH ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-6266
Practice Address - Country:US
Practice Address - Phone:870-390-6496
Practice Address - Fax:870-836-0264
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005486101YP2500X
ARP0010029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141479019Medicaid