Provider Demographics
NPI:1396872131
Name:DORSEY, SHANNON (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 VANCE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2348
Mailing Address - Country:US
Mailing Address - Phone:919-264-0991
Mailing Address - Fax:919-419-9353
Practice Address - Street 1:411 W CHAPEL HILL ST
Practice Address - Street 2:SUITE 908
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3616
Practice Address - Country:US
Practice Address - Phone:919-419-3474
Practice Address - Fax:919-419-9353
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical