Healthcare Provider Details

I. General information

NPI: 1669161428
Provider Name (Legal Business Name): JULIE ANNA DOSTER DODGE LMHC, ATR-P, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 S BURLINGTON BLVD STE 105
BURLINGTON WA
98233-1717
US

IV. Provider business mailing address

281 S BURLINGTON BLVD STE 105
BURLINGTON WA
98233-1717
US

V. Phone/Fax

Practice location:
  • Phone: 360-230-8321
  • Fax:
Mailing address:
  • Phone: 360-230-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61539526
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number21-497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: