Provider Demographics
NPI:1427549351
Name:DIMAYA, DORIS (PLPC)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:DIMAYA
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5266 HACKMANN RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MO
Mailing Address - Zip Code:63332-1733
Mailing Address - Country:US
Mailing Address - Phone:636-357-3816
Mailing Address - Fax:
Practice Address - Street 1:103 LIBERTY PLZ
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1163
Practice Address - Country:US
Practice Address - Phone:636-357-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018014426101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor