Provider Demographics
NPI:1316011240
Name:WINDSOROVA, DORA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:
Last Name:WINDSOROVA
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 1:800 E. CHEVES ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506
Mailing Address - Country:US
Mailing Address - Phone:843-662-3330
Mailing Address - Fax:843-662-3315
Practice Address - Street 1:901 E CHEVES ST
Practice Address - Street 2:SUITE 460
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-662-3330
Practice Address - Fax:843-662-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ311110281Medicare ID - Type Unspecified