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NPI Code Detail

MEDICARE: DORENZA THERESA FREDERICK JOYCE LCMHCA, NCC

MEDICARE: DORENZA THERESA FREDERICK JOYCE LCMHCA, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorA15798NC

General Provider Information

NPI Number : 1992303952
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORENZA THERESA FREDERICK JOYCE LCMHCA, NCC
Provider Business Mailing Address
First Line : PO BOX 12261
Second Line :
City : DURHAM
State : NC
Zip : 27709-2261
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1205 S MAIN ST
Second Line :
City : BURLINGTON
State : NC
Zip : 27215-5762
Country : US
Telephone Number : 336-494-5743
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2020
Last Update Date : 10/13/2020

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