Healthcare Provider Details

I. General information

NPI: 1861459844
Provider Name (Legal Business Name): ANNE DORRE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 OHIA ST SUITE D
KAPAA HI
96746-1646
US

IV. Provider business mailing address

4919 PEPELANI LOOP SUITE 8C
PRINCEVILLE HI
96722-5357
US

V. Phone/Fax

Practice location:
  • Phone: 808-634-0569
  • Fax:
Mailing address:
  • Phone: 808-634-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1170
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3674
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: