Provider Demographics
NPI:1487164356
Name:DOVE, ROBERT BRIAN (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRIAN
Last Name:DOVE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N ALICIA DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4302
Mailing Address - Country:US
Mailing Address - Phone:901-337-2032
Mailing Address - Fax:
Practice Address - Street 1:4515 POPLAR AVE STE 419
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7508
Practice Address - Country:US
Practice Address - Phone:901-337-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000034731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical