Healthcare Provider Details

I. General information

NPI: 1164133831
Provider Name (Legal Business Name): DORI FORD CMPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 JOANN ST
COSTA MESA CA
92626-6455
US

IV. Provider business mailing address

250 JOANN ST
COSTA MESA CA
92626-6455
US

V. Phone/Fax

Practice location:
  • Phone: 949-631-9041
  • Fax:
Mailing address:
  • Phone: 714-330-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-GERHAK
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: