Provider Demographics
NPI:1427156785
Name:DORETHY, JAMES ANTHONY (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANTHONY
Last Name:DORETHY
Suffix:
Gender:M
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 TUCKER CEMETARY RD
Mailing Address - Street 2:
Mailing Address - City:GASSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72635-8730
Mailing Address - Country:US
Mailing Address - Phone:870-508-8614
Mailing Address - Fax:501-257-3164
Practice Address - Street 1:405 BUTTERCUP DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2910
Practice Address - Country:US
Practice Address - Phone:870-508-8614
Practice Address - Fax:501-257-3164
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1566-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical