Provider Demographics
NPI:1982953014
Name:DODGE, JANETTE ROBINSON (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:ROBINSON
Last Name:DODGE
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-0413
Mailing Address - Country:US
Mailing Address - Phone:530-957-1308
Mailing Address - Fax:
Practice Address - Street 1:6765 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8984
Practice Address - Country:US
Practice Address - Phone:530-622-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health