Provider Demographics
NPI:1417933052
Name:ROSENKE, DOROTHY H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:H
Last Name:ROSENKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:HARSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1129 HORSESHOE ROAD ACG
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8507
Mailing Address - Country:US
Mailing Address - Phone:252-335-2018
Mailing Address - Fax:252-335-9521
Practice Address - Street 1:1129 HORSESHOE ROAD ACG
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8507
Practice Address - Country:US
Practice Address - Phone:252-335-2018
Practice Address - Fax:252-335-9521
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2704103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC600151Medicaid
NC6000151Medicaid
2818034Medicare PIN