Provider Demographics
NPI:1609114149
Name:CORIZ, DOROTHY A (LADAC)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:A
Last Name:CORIZ
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 HIGHWAY 313
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6912
Mailing Address - Country:US
Mailing Address - Phone:505-867-3351
Mailing Address - Fax:505-867-3514
Practice Address - Street 1:1043 HIGHWAY 313
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6912
Practice Address - Country:US
Practice Address - Phone:505-867-3351
Practice Address - Fax:505-867-3514
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)