Provider Demographics
NPI:1669526141
Name:YONGUE, DODIE SHREE (LISW CP LMFT)
Entity type:Individual
Prefix:MS
First Name:DODIE
Middle Name:SHREE
Last Name:YONGUE
Suffix:
Gender:F
Credentials:LISW CP LMFT
Other - Prefix:MS
Other - First Name:SHREE
Other - Middle Name:
Other - Last Name:YONGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW CP LMFT
Mailing Address - Street 1:3519 PELHAM ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-234-6778
Mailing Address - Fax:864-234-2474
Practice Address - Street 1:3519 PELHAM ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-234-6778
Practice Address - Fax:864-234-2474
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLISW CP 3067104100000X
SCLMFT 226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q27851Medicare ID - Type Unspecified