Provider Demographics
NPI:1790284842
Name:DOTSON, LENORA (LSW)
Entity type:Individual
Prefix:
First Name:LENORA
Middle Name:
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 MAXINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-3658
Mailing Address - Country:US
Mailing Address - Phone:336-340-2986
Mailing Address - Fax:
Practice Address - Street 1:2540 MAXINE AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-3658
Practice Address - Country:US
Practice Address - Phone:336-340-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHS0900521104100000X
OHS.0900521104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker