Provider Demographics
NPI:1982959961
Name:DORE, CARISSA LYNETTE (LMHC)
Entity type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:LYNETTE
Last Name:DORE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 YELLOW BLUFF RD STE 107
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-5070
Mailing Address - Country:US
Mailing Address - Phone:904-339-5937
Mailing Address - Fax:
Practice Address - Street 1:12400 YELLOW BLUFF RD STE 107
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-5070
Practice Address - Country:US
Practice Address - Phone:904-339-5937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health