Provider Demographics
NPI:1932229069
Name:DOREY, ANITA ELAINE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:ELAINE
Last Name:DOREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 JACKSON ST SW
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-3941
Mailing Address - Country:US
Mailing Address - Phone:870-836-5743
Mailing Address - Fax:870-836-6924
Practice Address - Street 1:211 JACKSON ST SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3941
Practice Address - Country:US
Practice Address - Phone:870-836-5743
Practice Address - Fax:870-836-6924
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARA0807045101Y00000X
ARP1008055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARNONEOtherMENTAL HEALTH PARAPROFESS