Provider Demographics
NPI:1295928604
Name:DODSON, MARIELOUISE S (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARIELOUISE
Middle Name:S
Last Name:DODSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S 333RD ST
Mailing Address - Street 2:THE AGENCY CENTER BLDG.
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6309
Mailing Address - Country:US
Mailing Address - Phone:253-929-1530
Mailing Address - Fax:253-946-0867
Practice Address - Street 1:402 S 333RD ST
Practice Address - Street 2:THE AGENCY CENTER BLDG.
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6309
Practice Address - Country:US
Practice Address - Phone:253-929-1530
Practice Address - Fax:253-946-0867
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004015101YA0400X
WALH00011011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)