Provider Demographics
NPI:1679975742
Name:SMITH, DOROTHY LEE (LSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LARCHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8907
Mailing Address - Country:US
Mailing Address - Phone:972-765-1270
Mailing Address - Fax:
Practice Address - Street 1:125 LARCHBROOK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8907
Practice Address - Country:US
Practice Address - Phone:972-765-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX097351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical