Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | LCS9548 | CA |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCS9548 | CA |
N | 101YM0800X | Mental Health Counselor | LCS9548 | CA |
N | 101YP1600X | Pastoral Counselor | LCS9548 | CA |
N | 101YP2500X | Professional Counselor | LCS9548 | CA |
N | 102L00000X | Psychologist | LCS9548 | CA |
N | 103T00000X | Psychologist | LCS9548 | CA |
N | 102L00000X | Psychologist | LCS9548 | CA |
N | 103T00000X | Psychologist | LCS9548 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | LCS9548 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | LCS9548 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | LCS9548 | CA |
N | 103TC1900X | Counseling Psychologist | LCS9548 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LCS9548 | CA |
N | 103TE1100X | Exercise & Sports Psychologist | LCS9548 | CA |
N | 103TF0000X | Family Psychologist | LCS9548 | CA |
NPI | 1598154676 |
---|---|
Provider Name | Jonathan Dorsey |
First Address | Riverside, CA 92506-1627 |
Second Address | Riverside, CA 92506-1627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2015 |
Last Update Date | 13/01/2015 |