Healthcare Provider Details

I. General information

NPI: 1639943376
Provider Name (Legal Business Name): STEPHANIE DORSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 LEGACY DR
PAINESVILLE OH
44077-8209
US

IV. Provider business mailing address

766 LEGACY DR
PAINESVILLE OH
44077-8209
US

V. Phone/Fax

Practice location:
  • Phone: 216-799-2520
  • Fax:
Mailing address:
  • Phone: 216-799-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.192472
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: