Healthcare Provider Details

I. General information

NPI: 1336838648
Provider Name (Legal Business Name): HEIDI LYNN DORSEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FOREST DR STE 302
COLUMBIA SC
29204-4057
US

IV. Provider business mailing address

7688 ANVIL DR
FREDERICK MD
21701-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-501-1099
  • Fax: 843-405-2040
Mailing address:
  • Phone: 443-289-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR197274
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number29369
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: