Provider Demographics
NPI:1699022566
Name:DORSEY, DAVID SAMUEL (LCSW, LISW-CP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SAMUEL
Last Name:DORSEY
Suffix:
Gender:M
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 HYDRANGEA PLACE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 PALMETTO PARK BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7872
Practice Address - Country:US
Practice Address - Phone:803-996-1500
Practice Address - Fax:803-996-1510
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2022-09-02
Deactivation Date:2014-09-17
Deactivation Code:
Reactivation Date:2022-09-02
Provider Licenses
StateLicense IDTaxonomies
NCC0071171041C0700X
SC105311041C0700X
NC10531041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool