Provider Demographics
NPI: | 1437267515 |
---|---|
Name: | DEMATO, DORIS (PH D, LPC) |
Entity Type: | Individual |
Prefix: | |
First Name: | DORIS |
Middle Name: | |
Last Name: | DEMATO |
Suffix: | |
Gender: | F |
Credentials: | PH D, LPC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2811 LINKHORNE DR |
Mailing Address - Street 2: | STE. B |
Mailing Address - City: | LYNCHBURG |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 24503-3321 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 434-384-1594 |
Mailing Address - Fax: | 434-384-3228 |
Practice Address - Street 1: | 2811 LINKHORNE DR |
Practice Address - Street 2: | STE. B |
Practice Address - City: | LYNCHBURG |
Practice Address - State: | VA |
Practice Address - Zip Code: | 24503-3321 |
Practice Address - Country: | US |
Practice Address - Phone: | 434-384-1594 |
Practice Address - Fax: | 434-384-3228 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-28 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0701002110 | 101YP2500X |
VA | 0717000239 | 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
Not Answered | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 281201 | Other | ANTHEM |