Basic Information
| Provider Information | |||||||||
| NPI: | 1316296395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORN | ||||||||
| FirstName: | MARLON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 ROANOKE RD | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920204015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195883653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 165 ROANOKE RD | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920204015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195883653 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.