Provider Demographics
NPI:1770038077
Name:DOBSON, MICHEA ALYSE
Entity Type:Individual
Prefix:
First Name:MICHEA
Middle Name:ALYSE
Last Name:DOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 TWINLAKES DR
Mailing Address - Street 2:408
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3115
Mailing Address - Country:US
Mailing Address - Phone:301-523-1756
Mailing Address - Fax:
Practice Address - Street 1:11800 TWINLAKES DR
Practice Address - Street 2:408
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3115
Practice Address - Country:US
Practice Address - Phone:301-523-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool