Provider Demographics
NPI:1265426449
Name:DODGE-SMITH, MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:DODGE-SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:DODGE-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1829 E FRANKLIN ST STE 1100B
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5804
Mailing Address - Country:US
Mailing Address - Phone:919-451-1954
Mailing Address - Fax:919-932-1508
Practice Address - Street 1:1829 E FRANKLIN ST STE 1100B
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5804
Practice Address - Country:US
Practice Address - Phone:919-451-1954
Practice Address - Fax:919-932-1508
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0003751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11339005OtherCAQH
NC28665OtherBLUE CROSS & BLUE SHIELD