Provider Demographics
NPI:1962933259
Name:DORSEY, LISA (CDCA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:2976 MUFFIN WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-8620
Mailing Address - Country:US
Mailing Address - Phone:614-373-5768
Mailing Address - Fax:
Practice Address - Street 1:1791 ALUM CREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1708
Practice Address - Country:US
Practice Address - Phone:614-445-8131
Practice Address - Fax:614-444-3092
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH120319101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)