Healthcare Provider Details

I. General information

NPI: 1770038077
Provider Name (Legal Business Name): MICHEA ALYSE DOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 TWINLAKES DR 408
BELTSVILLE MD
20705-3115
US

IV. Provider business mailing address

11800 TWINLAKES DR 408
BELTSVILLE MD
20705-3115
US

V. Phone/Fax

Practice location:
  • Phone: 301-523-1756
  • Fax:
Mailing address:
  • Phone: 301-523-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: