Provider Demographics
NPI:1053074856
Name:DORRIS, CAROLINE ELIZABETH (LISW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:DORRIS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:DORRIS
Other - Last Name:HAWFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:793 GARDENDALE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5022
Mailing Address - Country:US
Mailing Address - Phone:843-442-9962
Mailing Address - Fax:
Practice Address - Street 1:793 GARDENDALE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5022
Practice Address - Country:US
Practice Address - Phone:843-442-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC147511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical