Basic Information
| Provider Information | |||||||||
| NPI: | 1245364181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARNER | ||||||||
| FirstName: | DORIS | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8420 FOLLOW DITCH RD | ||||||||
| Address2: | |||||||||
| City: | WESTOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218713024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109573108 | ||||||||
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| Practice Location | |||||||||
| Address1: | POCOMOKE HEALTH CENTER | ||||||||
| Address2: | 400A WALNUT STREET | ||||||||
| City: | POCOMOKE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109572005 | ||||||||
| FaxNumber: | 4109572417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 08/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 02514 | MD | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 705371101 | 05 | MD | MEDICAID |