Provider Demographics
NPI:1811185499
Name:DOCKERY, DWIGHT KENNETH II
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:KENNETH
Last Name:DOCKERY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3735
Mailing Address - Country:US
Mailing Address - Phone:302-652-1405
Mailing Address - Fax:302-652-1403
Practice Address - Street 1:2303 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3735
Practice Address - Country:US
Practice Address - Phone:302-652-1405
Practice Address - Fax:302-652-1403
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)