Provider Demographics
NPI:1972826972
Name:DODGE, CAROLYN R (CADC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:R
Last Name:DODGE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:DIXMONT
Mailing Address - State:ME
Mailing Address - Zip Code:04932-0044
Mailing Address - Country:US
Mailing Address - Phone:207-944-3454
Mailing Address - Fax:
Practice Address - Street 1:1 JEWELL ROAD
Practice Address - Street 2:
Practice Address - City:DIXMONT
Practice Address - State:ME
Practice Address - Zip Code:04932-0044
Practice Address - Country:US
Practice Address - Phone:207-944-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC3658101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)