Provider Demographics
NPI:1629215603
Name:WELLINGTON, DOROTHY (BA ORDAINED CLERGY)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:BA ORDAINED CLERGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 N 12TH ST
Mailing Address - Street 2:SUITE 100-G
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4956
Mailing Address - Country:US
Mailing Address - Phone:602-593-5903
Mailing Address - Fax:
Practice Address - Street 1:4143 N 12TH ST
Practice Address - Street 2:SUITE 100-G
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4956
Practice Address - Country:US
Practice Address - Phone:602-593-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZORDINATION CERTIFICA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor