Provider Demographics
NPI:1275897555
Name:CYNTHIA DORER, INC.
Entity Type:Organization
Organization Name:CYNTHIA DORER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DORER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-591-8000
Mailing Address - Street 1:225 CREEKSTONE RDG
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3744
Mailing Address - Country:US
Mailing Address - Phone:770-591-8000
Mailing Address - Fax:770-591-7060
Practice Address - Street 1:225 CREEKSTONE RDG
Practice Address - Street 2:SUITE 8
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3744
Practice Address - Country:US
Practice Address - Phone:770-591-8000
Practice Address - Fax:770-591-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA483906800AMedicaid