Individual
MR. MICHAEL DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
901 W 3RD ST, FLORA, IL 62839-1287
(618) 662-2871
(618) 662-4748
Mailing address
504 MICAH DR, DRAWER M, OLNEY, IL 62450-4720
(618) 395-4506
(618) 395-4507
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/12/2012
Last updated
10/12/2012
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