Provider Demographics
NPI:1154922193
Name:ARISTY, DOREEN
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:ARISTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 UNION CEMETERY RD SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6836
Mailing Address - Country:US
Mailing Address - Phone:704-701-0085
Mailing Address - Fax:980-407-5557
Practice Address - Street 1:413 UNION CEMETERY RD SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6836
Practice Address - Country:US
Practice Address - Phone:704-701-0085
Practice Address - Fax:980-407-5557
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3254103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst