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Individual
MS. MARY DODGE-SMITH
Active
Individual
MS. MARY DODGE-SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
000375
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11339005
CAQH
NC
01
—
28665
BLUE CROSS & BLUE SHIELD
NC
Enumeration date
09/02/2005
Last updated
04/15/2020
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