Healthcare Provider Details

I. General information

NPI: 1811635824
Provider Name (Legal Business Name): NIKIANA DORSEY LCSW-C, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 DULANEY VALLEY RD
TIMONIUM MD
21093-2700
US

IV. Provider business mailing address

3920 NOYES CIR APT 102
RANDALLSTOWN MD
21133-2761
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-3105
  • Fax:
Mailing address:
  • Phone: 443-986-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20100
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number20100
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: