Provider Demographics
NPI:1366477796
Name:WESSELLS, DORSEY THOMAS JR (EDD)
Entity Type:Individual
Prefix:DR
First Name:DORSEY
Middle Name:THOMAS
Last Name:WESSELLS
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GRAHAM DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1422
Mailing Address - Country:US
Mailing Address - Phone:757-930-3925
Mailing Address - Fax:
Practice Address - Street 1:12420 WARWICK BLVD
Practice Address - Street 2:SUITE 7-C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3001
Practice Address - Country:US
Practice Address - Phone:757-595-3900
Practice Address - Fax:757-595-0649
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA332260OtherBC &BS
VA023905OtherVALUE OPTIONS ID #
VA5404622Medicaid