Provider Demographics
NPI:1316473259
Name:DORSON, JODI (LMFT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:DORSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20540 AVENIDA HACIENDA
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-2441
Mailing Address - Country:US
Mailing Address - Phone:951-299-6897
Mailing Address - Fax:
Practice Address - Street 1:20540 AVENIDA HACIENDA
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-2441
Practice Address - Country:US
Practice Address - Phone:951-299-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist