Healthcare Provider Details

I. General information

NPI: 1346264199
Provider Name (Legal Business Name): JAMES PETER DORAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10106 KRAUSE RD SUITE 100C
CHESTERFIELD VA
23832-6572
US

IV. Provider business mailing address

10106 KRAUSE RD SUITE 100C
CHESTERFIELD VA
23832-6572
US

V. Phone/Fax

Practice location:
  • Phone: 804-751-0277
  • Fax: 804-751-9086
Mailing address:
  • Phone: 804-751-0277
  • Fax: 804-751-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904000288
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: