Provider Demographics
NPI:1184217218
Name:DORIA, TARA LEIGH (MFT,MS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:DORIA
Suffix:
Gender:F
Credentials:MFT,MS
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT,MS
Mailing Address - Street 1:7040 TARA DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-3907
Mailing Address - Country:US
Mailing Address - Phone:561-809-8879
Mailing Address - Fax:
Practice Address - Street 1:6645 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1606
Practice Address - Country:US
Practice Address - Phone:770-455-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist