Provider Demographics
NPI:1730875725
Name:SANTIAGO, DORIS MARIE (MA)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:MARIE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 ROLLING FIELDS CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3540
Mailing Address - Country:US
Mailing Address - Phone:931-240-3627
Mailing Address - Fax:
Practice Address - Street 1:1016 ROLLING FIELDS CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3540
Practice Address - Country:US
Practice Address - Phone:931-240-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCA22432101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty