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General NPI Number Information
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NPI Number | 1467943654
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Entity Type | Individual
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Provider Name | CHARLOTTE ELIZABETH DODD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 2350 WASHTENAW AVE STE 3
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City | ANN ARBOR
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State | MI
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Zip | 48104-4526
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Country | US
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Telephone | 173-473-0734
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 WASHTENAW AVE STE 3
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City | ANN ARBOR
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State | MI
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Zip | 48104-4526
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Country | US
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Telephone | 734-730-7348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 6301014778
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License Number State | MI
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