Provider Demographics
NPI:1578221875
Name:DORSEY, TERENCE HAMMOND (RBT)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:HAMMOND
Last Name:DORSEY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:TERENCE
Other - Middle Name:HAMMOND
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:11350 PEMBROOKE SQ STE 313
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4809
Mailing Address - Country:US
Mailing Address - Phone:301-885-0033
Mailing Address - Fax:
Practice Address - Street 1:11350 PEMBROOKE SQ STE 313
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4809
Practice Address - Country:US
Practice Address - Phone:301-885-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-21-8115-346789103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst