Healthcare Provider Details

I. General information

NPI: 1255137667
Provider Name (Legal Business Name): DEXTER DODD MS, MDIV, BA,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 FAIRMOUNT AVE STE 200
TOWSON MD
21286-2693
US

IV. Provider business mailing address

825 CATOR AVE
BALTIMORE MD
21218-1227
US

V. Phone/Fax

Practice location:
  • Phone: 667-275-3095
  • Fax:
Mailing address:
  • Phone: 443-885-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA3520
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC17382
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: