MEDICARE: MS. CAROLYN R. DODGE CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC3658	ME

General Provider Information

NPI Number	:	1972826972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN R. DODGE CADC

Provider Business Mailing Address
First Line	:	PO BOX 44
Second Line	:
City	:	DIXMONT
State	:	ME
Zip	:	04932-0044
Country	:	US
Telephone Number	:	207-944-3454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 JEWELL ROAD
Second Line	:
City	:	DIXMONT
State	:	ME
Zip	:	04932-0044
Country	:	US
Telephone Number	:	207-944-3454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	01/04/2011

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