Provider Demographics
NPI:1699022566
Name:DORSEY, DAVID SAMUEL (LCSW, OTR/L, LSSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SAMUEL
Last Name:DORSEY
Suffix:
Gender:M
Credentials:LCSW, OTR/L, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 BARCLAY POINTE BLVD APT 11101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-1138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1720 BARCLAY POINTE BLVD APT 11101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-1138
Practice Address - Country:US
Practice Address - Phone:910-409-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2025-02-04
Deactivation Date:2014-09-17
Deactivation Code:
Reactivation Date:2022-09-02
Provider Licenses
StateLicense IDTaxonomies
NC10266751041S0200X
NC14089225X00000X
NCC0071171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist