Provider Demographics
NPI:1508942970
Name:DORITY, VERNA MAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VERNA
Middle Name:MAE
Last Name:DORITY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9909
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9094
Mailing Address - Country:US
Mailing Address - Phone:910-850-0367
Mailing Address - Fax:910-485-6572
Practice Address - Street 1:1310 RAEFORD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5085
Practice Address - Country:US
Practice Address - Phone:910-850-0367
Practice Address - Fax:910-485-6572
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0020191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28942OtherBLUE CROSS BLUE SHIELD
NC6002240Medicaid
NC6002240Medicaid