Provider Demographics
NPI:1912193939
Name:FLORES, DOEMIKO AMEIN (BACB)
Entity Type:Individual
Prefix:MRS
First Name:DOEMIKO
Middle Name:AMEIN
Last Name:FLORES
Suffix:
Gender:F
Credentials:BACB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ALLIGATOR BAY ROAD
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460
Mailing Address - Country:US
Mailing Address - Phone:615-294-1221
Mailing Address - Fax:910-327-2716
Practice Address - Street 1:1671 GUALO RAI ROAD
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:615-294-1221
Practice Address - Fax:910-327-2716
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000325103K00000X
1-07-3519174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist