Provider Demographics
NPI:1417566159
Name:DORSEY BEHAVIORAL HEALTH SPIRITUAL HEALING PLLC
Entity Type:Organization
Organization Name:DORSEY BEHAVIORAL HEALTH SPIRITUAL HEALING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUWA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:248-924-7439
Mailing Address - Street 1:25603 CRESTON MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-7285
Mailing Address - Country:US
Mailing Address - Phone:248-924-7439
Mailing Address - Fax:
Practice Address - Street 1:25603 CRESTON MEADOW DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-7285
Practice Address - Country:US
Practice Address - Phone:248-924-7439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty