Provider Demographics
NPI:1184110116
Name:DORSEY, KEISHAN LAVELLE (CDCAII)
Entity type:Individual
Prefix:MRS
First Name:KEISHAN
Middle Name:LAVELLE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:CDCAII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROBINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2731
Mailing Address - Country:US
Mailing Address - Phone:937-580-7055
Mailing Address - Fax:
Practice Address - Street 1:2261 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1814
Practice Address - Country:US
Practice Address - Phone:937-734-6750
Practice Address - Fax:937-277-7249
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165335101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)