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General NPI Number Information
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NPI Number | 1053734046
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Entity Type | Individual
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Provider Name | DORIC GEORGE MA, MFT, LPCC
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Gender | Male
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 23545 CRENSHAW BLVD STE 210
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City | TORRANCE
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State | CA
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Zip | 90505-5253
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Country | US
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Telephone | 310-717-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 WILSHIRE BLVD UNIT 771
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City | SANTA MONICA
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State | CA
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Zip | 90403-5406
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Country | US
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Telephone | 310-717-1771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC208
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC38343
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License Number State | CA
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