Provider Demographics
NPI:1245581297
Name:NELSON, DOROTHY DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:DENISE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:D
Other - Middle Name:DENISE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:964 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4072
Mailing Address - Country:US
Mailing Address - Phone:928-279-1662
Mailing Address - Fax:
Practice Address - Street 1:964 GATES AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4072
Practice Address - Country:US
Practice Address - Phone:928-279-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-29
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW118731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical