Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | MRW146 | SC |
NPI | 1164692497 |
---|---|
Provider Name | Michael Gene Dodson |
First Address | Aiken, SC 29803-4907 |
Second Address | Aiken, SC 29803-4907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2008 |
Last Update Date | 03/03/2008 |