Provider Demographics
NPI:1518375815
Name:VODDE, RICH (PHD SOCIAL)
Entity type:Individual
Prefix:DR
First Name:RICH
Middle Name:
Last Name:VODDE
Suffix:
Gender:M
Credentials:PHD SOCIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 DYKES POND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-2716
Mailing Address - Country:US
Mailing Address - Phone:229-630-9335
Mailing Address - Fax:
Practice Address - Street 1:5990 DYKES POND RD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636-2716
Practice Address - Country:US
Practice Address - Phone:229-630-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0016011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical