Healthcare Provider Details

I. General information

NPI: 1548953391
Provider Name (Legal Business Name): ANIE DORIMAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

15544 SMOKE BOX WAY
WOODBRIDGE VA
22191-5590
US

V. Phone/Fax

Practice location:
  • Phone: 434-666-8007
  • Fax:
Mailing address:
  • Phone: 516-395-5852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: