Provider Demographics
NPI:1912648635
Name:ANTWI, DORCAS
Entity Type:Individual
Prefix:
First Name:DORCAS
Middle Name:
Last Name:ANTWI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 W CHERYL DR STE B225
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9579
Mailing Address - Country:US
Mailing Address - Phone:480-406-1711
Mailing Address - Fax:
Practice Address - Street 1:3320 W CHERYL DR STE B225
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9579
Practice Address - Country:US
Practice Address - Phone:480-406-1711
Practice Address - Fax:602-675-0399
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2734122084P0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry