Provider Demographics
NPI:1497958268
Name:DOTTIE HARKLESS, LCSW-C, LLC
Entity Type:Organization
Organization Name:DOTTIE HARKLESS, LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYSCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HARKLESS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-695-2866
Mailing Address - Street 1:65 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4371
Mailing Address - Country:US
Mailing Address - Phone:301-695-2866
Mailing Address - Fax:
Practice Address - Street 1:65 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4371
Practice Address - Country:US
Practice Address - Phone:301-695-2866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicare UPIN