Provider Demographics
NPI:1992147524
Name:CRENSHAW, DORTHEA LYNN (LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:DORTHEA
Middle Name:LYNN
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 E SWAN CREEK RD STE 739
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5250
Mailing Address - Country:US
Mailing Address - Phone:202-997-4771
Mailing Address - Fax:
Practice Address - Street 1:938 E SWAN CREEK RD STE 739
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5250
Practice Address - Country:US
Practice Address - Phone:202-997-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500781341041C0700X
VA09040077031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical