Healthcare Provider Details

I. General information

NPI: 1093825671
Provider Name (Legal Business Name): DEIDRE G DORIA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MORRIS ST
CHARLESTON WV
25301
US

IV. Provider business mailing address

PO BOX 4009
CHARLESTON WV
25364-4009
US

V. Phone/Fax

Practice location:
  • Phone: 304-341-0511
  • Fax: 304-341-0197
Mailing address:
  • Phone: 304-348-1288
  • Fax: 304-348-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP00939207
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: