Provider Demographics
NPI:1356048409
Name:DORIA, DOUGLAS (LCPC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:DORIA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CERRO CREST DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ALBERTON
Practice Address - State:MT
Practice Address - Zip Code:59820-9499
Practice Address - Country:US
Practice Address - Phone:805-509-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT62346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health