Provider Demographics
NPI:1285754473
Name:LEBEAU, DORIAN CHARLES (MSW, LCSW, LISW)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:CHARLES
Last Name:LEBEAU
Suffix:
Gender:M
Credentials:MSW, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W WESTCHESTER PKWY APT 9203
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3275
Mailing Address - Country:US
Mailing Address - Phone:419-280-8058
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD BLDG 69
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1254
Practice Address - Fax:214-462-4944
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 09001251041C0700X
LA87551041C0700X
TX540111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical