Provider Demographics
NPI:1477969384
Name:MENSAH, DORA WALKER (LCSW)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:WALKER
Last Name:MENSAH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NE 63RD ST RM 124
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-8305
Mailing Address - Country:US
Mailing Address - Phone:405-633-4653
Mailing Address - Fax:
Practice Address - Street 1:2700 NE 63RD ST RM 124
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-8305
Practice Address - Country:US
Practice Address - Phone:405-633-4653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical