Provider Demographics
NPI:1235421454
Name:WHITMAN, DORI LARA (LCSW)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:LARA
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 STALLIONS GLEN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0238
Mailing Address - Country:US
Mailing Address - Phone:917-806-5025
Mailing Address - Fax:
Practice Address - Street 1:10521 STALLIONS GLEN LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0238
Practice Address - Country:US
Practice Address - Phone:917-806-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006754251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health