Healthcare Provider Details

I. General information

NPI: 1265296321
Provider Name (Legal Business Name): KALI DORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 VENETIAN CT STE 1
NAPLES FL
34109-8727
US

IV. Provider business mailing address

3702 9TH ST SW
LEHIGH ACRES FL
33976-2802
US

V. Phone/Fax

Practice location:
  • Phone: 239-236-5448
  • Fax:
Mailing address:
  • Phone: 603-393-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: