Provider Demographics
NPI:1841516341
Name:DORSEY, BEVERLY YVETTE (EDD, NCC, LPC, MAC)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:YVETTE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:EDD, NCC, LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 PORTWEST WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3273
Mailing Address - Country:US
Mailing Address - Phone:404-644-3899
Mailing Address - Fax:
Practice Address - Street 1:1798 PORTWEST WAY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3273
Practice Address - Country:US
Practice Address - Phone:404-644-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA827748501AMedicaid