Healthcare Provider Details

I. General information

NPI: 1699022566
Provider Name (Legal Business Name): DAVID SAMUEL DORSEY LCSW, OTR/L, LSSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date: 09/17/2014
Reactivation Date: 09/02/2022

III. Provider practice location address

1720 BARCLAY POINTE BLVD APT 11101
WILMINGTON NC
28412-1138
US

IV. Provider business mailing address

1720 BARCLAY POINTE BLVD APT 11101
WILMINGTON NC
28412-1138
US

V. Phone/Fax

Practice location:
  • Phone: 910-409-4629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007117
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1026675
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14089
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: