Provider Demographics
NPI:1255061297
Name:RODMAN, DAUNE W (MSW, LCSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:DAUNE
Middle Name:W
Last Name:RODMAN
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9203 RANDOM RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8735
Mailing Address - Country:US
Mailing Address - Phone:704-999-3942
Mailing Address - Fax:
Practice Address - Street 1:9203 RANDOM RD
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8735
Practice Address - Country:US
Practice Address - Phone:704-999-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109581041C0700X
NCC0077361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty