Provider Demographics
NPI:1124750088
Name:DATOR, DOROTHY MARIE (MA)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:DATOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3246
Mailing Address - Country:US
Mailing Address - Phone:336-970-8821
Mailing Address - Fax:
Practice Address - Street 1:1103 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6309
Practice Address - Country:US
Practice Address - Phone:336-272-6161
Practice Address - Fax:336-271-3724
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
NC103595103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral