Provider Demographics
NPI:1285192120
Name:PAEZ, DORIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:
Last Name:PAEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3502
Mailing Address - Country:US
Mailing Address - Phone:336-971-7685
Mailing Address - Fax:
Practice Address - Street 1:1024 WILDWOOD CENTRE DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8400
Practice Address - Country:US
Practice Address - Phone:803-781-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty