Provider Demographics
NPI:1598753121
Name:MCBRIDE, DORNA SUE (MC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DORNA
Middle Name:SUE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:DORNA
Other - Middle Name:SUE
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC, LPC
Mailing Address - Street 1:3707 E SOUTHERN AVE STE 2014
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6213
Mailing Address - Country:US
Mailing Address - Phone:480-688-5864
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE STE 2014
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6213
Practice Address - Country:US
Practice Address - Phone:480-688-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11733101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health