Provider Demographics
NPI:1245439504
Name:STABP, DORIS M (LISW-CP)
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:M
Last Name:STABP
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 WADE HAMPTON BLVD STE C
Mailing Address - Street 2:STE.1-B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4947
Mailing Address - Country:US
Mailing Address - Phone:570-994-4386
Mailing Address - Fax:
Practice Address - Street 1:850 WADE HAMPTON BLVD STE C
Practice Address - Street 2:STE.1-B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4947
Practice Address - Country:US
Practice Address - Phone:570-994-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSW102871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical