Provider Demographics
NPI:1346346525
Name:CANCINO, DOLORES ERIKA (LCSW-BACS)
Entity type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:ERIKA
Last Name:CANCINO
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:MS
Other - First Name:DOLORES
Other - Middle Name:CANCINO
Other - Last Name:CLEMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-BACS
Mailing Address - Street 1:5213 JERRAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875
Mailing Address - Country:US
Mailing Address - Phone:307-240-0879
Mailing Address - Fax:
Practice Address - Street 1:5213 JERRAL DRIVE
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875
Practice Address - Country:US
Practice Address - Phone:307-240-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA61681041C0700X
VA09040170431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical