Provider Demographics
NPI:1841402575
Name:MINGO, DOROTHY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JEAN
Last Name:MINGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 NORMAN BERRY DR
Mailing Address - Street 2:SUITE 254
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5121
Mailing Address - Country:US
Mailing Address - Phone:404-349-4971
Mailing Address - Fax:
Practice Address - Street 1:3401 NORMAN BERRY DR
Practice Address - Street 2:SUITE 254
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5121
Practice Address - Country:US
Practice Address - Phone:404-349-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0015241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical