Provider Demographics
NPI:1245364181
Name:GARNER, DORIS C (PHD)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:C
Last Name:GARNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 FOLLOW DITCH RD
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21871-3024
Mailing Address - Country:US
Mailing Address - Phone:410-957-3108
Mailing Address - Fax:
Practice Address - Street 1:POCOMOKE HEALTH CENTER
Practice Address - Street 2:400A WALNUT STREET
Practice Address - City:POCOMOKE
Practice Address - State:MD
Practice Address - Zip Code:21851
Practice Address - Country:US
Practice Address - Phone:410-957-2005
Practice Address - Fax:410-957-2417
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MD705371101Medicaid