person
Richard Lornal Dodge, PHDCADCIIICRE
Addiction (Substance Use Disorder) Counselor in Gautier, Mississippi
NPI 1639114663

Richard Lornal Dodge is an Addiction (Substance Use Disorder) Counselor based in Gautier, MS and is specialized in Addiction (Substance Use Disorder). Richard Lornal Dodge practices in Gautier, MS and has the professional credentials of PHDCADCIIICRE. The NPI Number for Richard Lornal Dodge is 1639114663 and holds a License No. A8424202 (Mississippi).

The current practice location address for Richard Lornal Dodge is 3407 Shamrock Ct, Gautier, MS and can be reached out via phone at 228-497-0690 and via fax at 228-497-1363.

Location: 3407 Shamrock Ct, Gautier, MS, 39553
person
Provider Profile Details
NPI Number
1639114663
Provider Name
Richard Lornal Dodge
Credential
PHDCADCIIICRE
Provider Entity Type
Individual
Gender
Male
Address
3407 Shamrock Ct, Gautier, MS, 39553
Phone Number
228-497-0690
Fax Number
228-497-1363
Provider Enumeration Date
06/16/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00018214 05 MS
institution
Provider Business Practice Location Address Details
Address
3407 Shamrock Ct
City
State
Zip
39553
Phone Number
228-497-0690
Fax Number
228-497-1363
person
Provider Business Mailing Address Details
Address
3407 Shamrock Ct
City
State
Zip
39553
Phone Number
228-497-0690
Fax Number
228-497-1363
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
A8424202 (California)
Definition
Definition to come...
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