Provider Demographics
NPI:1346901840
Name:DORMER, JOEL MICHAEL (AMFT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:MICHAEL
Last Name:DORMER
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 SONOMA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3008
Mailing Address - Country:US
Mailing Address - Phone:530-351-4151
Mailing Address - Fax:
Practice Address - Street 1:2157 SONOMA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3008
Practice Address - Country:US
Practice Address - Phone:530-351-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128880251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)