Provider Demographics
NPI:1427374255
Name:DORE, ITA G
Entity Type:Individual
Prefix:MRS
First Name:ITA
Middle Name:G
Last Name:DORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ITA
Other - Middle Name:G
Other - Last Name:DORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:409 OLD BORING LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-2495
Mailing Address - Country:US
Mailing Address - Phone:770-928-7300
Mailing Address - Fax:770-928-7558
Practice Address - Street 1:409 OLD BORING LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-2495
Practice Address - Country:US
Practice Address - Phone:770-928-7300
Practice Address - Fax:770-928-7558
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional