Provider Demographics
NPI:1134669856
Name:DOTSON, CAROLINE GRACE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:GRACE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:GRACE
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1900 W SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2240
Mailing Address - Country:US
Mailing Address - Phone:417-862-7041
Mailing Address - Fax:
Practice Address - Street 1:1900 W SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2240
Practice Address - Country:US
Practice Address - Phone:417-862-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160407621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical