Provider Demographics
NPI:1033683453
Name:HARRELL, DOSHA MAE (MSW)
Entity Type:Individual
Prefix:
First Name:DOSHA
Middle Name:MAE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:DOSHA
Other - Middle Name:MAE
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 BEAR ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1705
Mailing Address - Country:US
Mailing Address - Phone:812-265-4513
Mailing Address - Fax:
Practice Address - Street 1:1405 BEAR ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1705
Practice Address - Country:US
Practice Address - Phone:812-265-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker