Healthcare Provider Details

I. General information

NPI: 1629218391
Provider Name (Legal Business Name): CARRIE LYNN DODRILL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 BROADWAY STE 311
ALAMO HEIGHTS TX
78209-5744
US

IV. Provider business mailing address

4940 BROADWAY STE 311
ALAMO HEIGHTS TX
78209-5744
US

V. Phone/Fax

Practice location:
  • Phone: 832-753-4246
  • Fax:
Mailing address:
  • Phone: 328-753-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: