Individual
MR. KENNETH BART DODSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 N COCHITI AVE, FARMINGTON, NM 87401-4237
(505) 613-6909
Mailing address
PO BOX 322, FARMINGTON, NM 87499-0322
(505) 613-6909
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0139981
NM
1041C0700X
Clinical Social Worker
Primary
C09762
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N0001955
—
NM
Enumeration date
07/20/2011
Last updated
04/03/2025
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