Provider Demographics
NPI:1689166563
Name:TANNER, DORANN WILBURN (LICSW)
Entity Type:Individual
Prefix:
First Name:DORANN
Middle Name:WILBURN
Last Name:TANNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 WYNLAKE CV
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-7647
Mailing Address - Country:US
Mailing Address - Phone:205-506-1667
Mailing Address - Fax:
Practice Address - Street 1:627 WYNLAKE CV
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-7647
Practice Address - Country:US
Practice Address - Phone:205-506-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2488C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical