Provider Demographics
NPI:1609626696
Name:DORSEY, TOMMIE (PASTOR, CD)
Entity type:Individual
Prefix:MS
First Name:TOMMIE
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:PASTOR, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-0038
Mailing Address - Country:US
Mailing Address - Phone:307-683-0858
Mailing Address - Fax:
Practice Address - Street 1:1561 7TH AVE APT 102
Practice Address - Street 2:
Practice Address - City:OLIVEHURST
Practice Address - State:CA
Practice Address - Zip Code:95961-4253
Practice Address - Country:US
Practice Address - Phone:530-415-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 374J00000X
CA003150963172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No172V00000XOther Service ProvidersCommunity Health Worker