Provider Demographics
NPI:1306389564
Name:MCDERMOTT, DOROTHY (LPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 POINTER DR SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3361
Mailing Address - Country:US
Mailing Address - Phone:256-365-7654
Mailing Address - Fax:
Practice Address - Street 1:1315 POINTER DR SW
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3361
Practice Address - Country:US
Practice Address - Phone:256-365-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional