Provider Demographics
NPI:1225604168
Name:DORE, DWAYNE RUSSELL I (CADCII)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:RUSSELL
Last Name:DORE
Suffix:I
Gender:M
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 HARTNELL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1881
Mailing Address - Country:US
Mailing Address - Phone:530-999-2626
Mailing Address - Fax:
Practice Address - Street 1:376 HARTNELL AVE STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1881
Practice Address - Country:US
Practice Address - Phone:530-999-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA05120315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)