Provider Demographics
NPI:1669161428
Name:DODGE, JULIE ANNA DOSTER (LMHC, ATR-P, MA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNA DOSTER
Last Name:DODGE
Suffix:
Gender:F
Credentials:LMHC, ATR-P, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 S BURLINGTON BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1717
Mailing Address - Country:US
Mailing Address - Phone:360-230-8321
Mailing Address - Fax:
Practice Address - Street 1:281 S BURLINGTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1717
Practice Address - Country:US
Practice Address - Phone:360-230-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21-497221700000X
WALH61539526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist