Provider Demographics
NPI:1649367673
Name:DODD, LISA JOANNE (MC, LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JOANNE
Last Name:DODD
Suffix:
Gender:F
Credentials:MC, LPC
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 387
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-0387
Mailing Address - Country:US
Mailing Address - Phone:602-708-3358
Mailing Address - Fax:623-535-8242
Practice Address - Street 1:549 E PLAZA CIR
Practice Address - Street 2:SUIT A
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4918
Practice Address - Country:US
Practice Address - Phone:602-708-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health