Provider Demographics
NPI:1114251063
Name:VOSBURG, DOREEN MAE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:MAE
Last Name:VOSBURG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 12TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6044
Mailing Address - Country:US
Mailing Address - Phone:701-235-2092
Mailing Address - Fax:
Practice Address - Street 1:2913 12TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6044
Practice Address - Country:US
Practice Address - Phone:701-235-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND504-3-1-04-189101YM0800X
MN00178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health