Provider Demographics
NPI:1700653078
Name:DORSEY-WILLIAMS, RODDERICK DEANDRE (LCSW)
Entity Type:Individual
Prefix:
First Name:RODDERICK
Middle Name:DEANDRE
Last Name:DORSEY-WILLIAMS
Suffix:
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 1:2219 TOWN CENTER DR SE APT 187
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4033
Mailing Address - Country:US
Mailing Address - Phone:312-399-0412
Mailing Address - Fax:
Practice Address - Street 1:1436 U ST NW STE 401
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3988
Practice Address - Country:US
Practice Address - Phone:202-506-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490239681041C0700X
DCLC2000029821041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical