Provider Demographics
NPI:1578076089
Name:WEBB, DORTHA (LCDC)
Entity Type:Individual
Prefix:
First Name:DORTHA
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001A W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2206
Mailing Address - Country:US
Mailing Address - Phone:817-338-0311
Mailing Address - Fax:817-332-9075
Practice Address - Street 1:3001A W 5TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2206
Practice Address - Country:US
Practice Address - Phone:817-338-0311
Practice Address - Fax:817-332-9075
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11584101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11584OtherTEXAS DEPT OF STATE HEALTH SERVICES