Provider Demographics
NPI:1053003947
Name:DORSEY, MIKARA
Entity type:Individual
Prefix:
First Name:MIKARA
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 KIRKORIAN CT
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4556
Mailing Address - Country:US
Mailing Address - Phone:831-295-1108
Mailing Address - Fax:
Practice Address - Street 1:2335 AMERICAN RIVER DR STE 301
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7088
Practice Address - Country:US
Practice Address - Phone:530-648-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health