Provider Demographics
NPI:1053891804
Name:DODSON, AMANDA CAITLIN BIRDWELL (LPC-MHSP, NCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAITLIN BIRDWELL
Last Name:DODSON
Suffix:
Gender:F
Credentials:LPC-MHSP, NCC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CAITLIN
Other - Last Name:BIRDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP, NCC
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-1223
Mailing Address - Country:US
Mailing Address - Phone:931-265-5473
Mailing Address - Fax:
Practice Address - Street 1:106 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3352
Practice Address - Country:US
Practice Address - Phone:931-265-5473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health