Individual
DORETHA PRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
108 MIMOSA DR, FORT VALLEY, GA 31030-3717
(478) 825-9045
Mailing address
108 MIMOSA DR, FORT VALLEY, GA 31030-3717
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/15/2017
Last updated
02/15/2017
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