Provider Demographics
NPI:1043980774
Name:DORKO, KORMAH (LPC, AADC)
Entity Type:Individual
Prefix:
First Name:KORMAH
Middle Name:
Last Name:DORKO
Suffix:
Gender:M
Credentials:LPC, AADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 S HICO ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3740
Mailing Address - Country:US
Mailing Address - Phone:479-278-3130
Mailing Address - Fax:
Practice Address - Street 1:608 S HICO ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3740
Practice Address - Country:US
Practice Address - Phone:479-549-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)