Provider Demographics
NPI:1457561128
Name:DORGAN, CAROL ANN (PH D)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:DORGAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 N US HIGHWAY 1
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3237
Mailing Address - Country:US
Mailing Address - Phone:561-743-6692
Mailing Address - Fax:561-745-0456
Practice Address - Street 1:1340 N US HIGHWAY 1
Practice Address - Street 2:SUITE 102
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3237
Practice Address - Country:US
Practice Address - Phone:561-743-6692
Practice Address - Fax:561-745-0456
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health