Provider Demographics
NPI:1386870269
Name:CLARKE-PINE, DORA (PHD)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:CLARKE-PINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28545 FELIX VALDEZ AVE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-1859
Mailing Address - Country:US
Mailing Address - Phone:951-240-5250
Mailing Address - Fax:
Practice Address - Street 1:28545 FELIX VALDEZ AVE
Practice Address - Street 2:SUITE B-1
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-1859
Practice Address - Country:US
Practice Address - Phone:951-240-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral