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General NPI Number Information
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NPI Number | 1578687539
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Entity Type | Individual
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Provider Name | DONNA MARIE DORTY MFT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 4211 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90011-5622
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Country | US
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Telephone | 323-432-5185
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Fax | 323-432-5086
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Provider Business Mailing Address
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Address Line | 4611 W MARTIN LUTHER KING JR BLVD APARTMENT #287
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City | LOS ANGELES
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State | CA
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Zip | 90016-5556
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Country | US
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Telephone | 323-586-7333
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Fax | 323-319-1998
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 49269
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License Number State | CA
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