Provider Demographics
NPI:1649744947
Name:DORCE, EVELYNMARIE SABRINAH
Entity Type:Individual
Prefix:
First Name:EVELYNMARIE
Middle Name:SABRINAH
Last Name:DORCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 COMMERCE TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7572
Mailing Address - Country:US
Mailing Address - Phone:914-275-1477
Mailing Address - Fax:
Practice Address - Street 1:840 COMMERCE TRL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7572
Practice Address - Country:US
Practice Address - Phone:914-275-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist