Provider Demographics
NPI:1568117240
Name:SAN INOCENCIO, TORI (ALC)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:SAN INOCENCIO
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:GILLASPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4765
Mailing Address - Country:US
Mailing Address - Phone:334-794-2113
Mailing Address - Fax:
Practice Address - Street 1:1450 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4765
Practice Address - Country:US
Practice Address - Phone:334-794-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health