Provider Demographics
NPI:1205950599
Name:DORSEY, BETTY L (LPA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:DORSEY
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 7 LKS N
Mailing Address - Street 2:PO BOX 9
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-9756
Mailing Address - Country:US
Mailing Address - Phone:910-673-9111
Mailing Address - Fax:910-673-6202
Practice Address - Street 1:110 W WALKER AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6760
Practice Address - Country:US
Practice Address - Phone:336-633-7043
Practice Address - Fax:336-625-4969
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NC0755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107288Medicaid