Provider Demographics
NPI:1174755235
Name:DOVERS, RICKEY (MS, LCDC, LBSW)
Entity type:Individual
Prefix:
First Name:RICKEY
Middle Name:
Last Name:DOVERS
Suffix:
Gender:M
Credentials:MS, LCDC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N BELT LINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-4069
Mailing Address - Country:US
Mailing Address - Phone:972-400-8481
Mailing Address - Fax:
Practice Address - Street 1:1000 N BELT LINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4069
Practice Address - Country:US
Practice Address - Phone:972-400-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1526-1000101Y00000X
TXF17929101Y00000X
TX3625101YA0400X
TX22770104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker