Doctor Name: | MR. JOHN MATTHEW DORMAN |
NPI Number: | 1013009562 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 403 Stoney Landing Road Moncks Corner, SC - 294613967 |
Business Phone Number: | 8437618282 |
Business Fax Number: | 8437617308 |
Mailing Address: | P.o. Box 1030, MONCKS CORNER |
State: | SC |
Postal Code: | 294613967 |
Phone Number: | 8437618282 |
Fax Number: | 8437617308 |
NPI Enumeration Date: | 09/29/2006 |
NPI Last Update Date: | 07/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |