Healthcare Provider Details

I. General information

NPI: 1386424570
Provider Name (Legal Business Name): DORRETT CHONGE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 WINDING ROSE DR
HOSCHTON GA
30548-4442
US

IV. Provider business mailing address

1 EXECUTIVE BLVD STE 178
YONKERS NY
10701-6836
US

V. Phone/Fax

Practice location:
  • Phone: 585-698-6149
  • Fax:
Mailing address:
  • Phone: 800-465-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002336
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002369
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number06-P114065-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: