Provider Demographics
NPI:1700591922
Name:DOTSON, JASON MAURICE (LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MAURICE
Last Name:DOTSON
Suffix:
Gender:M
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2208
Mailing Address - Country:US
Mailing Address - Phone:973-851-7830
Mailing Address - Fax:
Practice Address - Street 1:159 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2208
Practice Address - Country:US
Practice Address - Phone:973-851-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor