Provider Demographics
NPI:1881099836
Name:PRESTON, DOROTHY (PHD)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:PRESTON
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 1:1646 N LITCHFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1203
Mailing Address - Country:US
Mailing Address - Phone:623-643-9598
Mailing Address - Fax:623-478-0960
Practice Address - Street 1:1646 N LITCHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1203
Practice Address - Country:US
Practice Address - Phone:623-643-9598
Practice Address - Fax:623-478-0960
Is Sole Proprietor?:No
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1638103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist