Provider Demographics
NPI:1346294105
Name:DOTSON, CHARMAINE Y (LICSW)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:Y
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0643
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:2801 DUDLEY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2105
Practice Address - Country:US
Practice Address - Phone:304-428-1114
Practice Address - Fax:304-428-1135
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP004553361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW29881Medicare ID - Type Unspecified