Provider Demographics
NPI:1811029895
Name:DORN, MELISSA KAYE
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAYE
Last Name:DORN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:KAYE
Other - Last Name:WEATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:395 BALLANTYNE ST
Mailing Address - Street 2:#305
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:395 BALLANTYNE ST
Practice Address - Street 2:#305
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3922
Practice Address - Country:US
Practice Address - Phone:609-588-3653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor