Provider Demographics
NPI:1255807806
Name:DODSON, JESSIE MARIE (MS)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:MARIE
Last Name:DODSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1526
Mailing Address - Country:US
Mailing Address - Phone:856-602-4642
Mailing Address - Fax:856-541-4139
Practice Address - Street 1:400 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1526
Practice Address - Country:US
Practice Address - Phone:856-602-4642
Practice Address - Fax:856-541-4139
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health