Healthcare Provider Details

I. General information

NPI: 1578495933
Provider Name (Legal Business Name): CHARLES DORSEY III LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 MARBLE AVE NE
ALBUQUERQUE NM
87110-6344
US

IV. Provider business mailing address

5000 MARBLE AVE NE
ALBUQUERQUE NM
87110-6344
US

V. Phone/Fax

Practice location:
  • Phone: 505-338-2266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWB-2026-0609
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: