Provider Demographics
NPI:1447704952
Name:MOHATT, DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MOHATT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2295
Mailing Address - Country:US
Mailing Address - Phone:334-503-7891
Mailing Address - Fax:
Practice Address - Street 1:3753 ROSS CLARK CIR
Practice Address - Street 2:SUITE 4
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2295
Practice Address - Country:US
Practice Address - Phone:334-503-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50841041C0700X
FLSW 98131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical