Provider Demographics
NPI:1093027492
Name:DVORSON, MIMI (BA)
Entity Type:Individual
Prefix:MS
First Name:MIMI
Middle Name:
Last Name:DVORSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 E 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1702
Mailing Address - Country:US
Mailing Address - Phone:541-687-8173
Mailing Address - Fax:
Practice Address - Street 1:1255 PEARL STREET
Practice Address - Street 2:OPTIONS COUNSELING SERVICES
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-687-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor