Provider Demographics
NPI:1548772668
Name:DEBBIE DODGE, LLC
Entity type:Organization
Organization Name:DEBBIE DODGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-371-6602
Mailing Address - Street 1:107 DR MARTIN LUTHER KING JR AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-4300
Mailing Address - Country:US
Mailing Address - Phone:856-371-6602
Mailing Address - Fax:352-419-8983
Practice Address - Street 1:107 DR MARTIN LUTHER KING JR AVE STE 2
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-4300
Practice Address - Country:US
Practice Address - Phone:856-371-6602
Practice Address - Fax:352-419-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14195251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health