Provider Demographics
NPI:1184284051
Name:DOTSON, JOHNNY PATRICK JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:PATRICK
Last Name:DOTSON
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 TOWNE PARK RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1607
Mailing Address - Country:US
Mailing Address - Phone:803-269-2468
Mailing Address - Fax:
Practice Address - Street 1:4716 TOWNE PARK RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-1607
Practice Address - Country:US
Practice Address - Phone:803-269-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67963104100000X
NCC0141881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker