Provider Demographics
NPI:1194392738
Name:DOUGE, NIKISHA
Entity Type:Individual
Prefix:
First Name:NIKISHA
Middle Name:
Last Name:DOUGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 SUGARLOAF PKWY STE 1108
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7832
Mailing Address - Country:US
Mailing Address - Phone:908-266-2731
Mailing Address - Fax:
Practice Address - Street 1:5415 SUGARLOAF PKWY STE 1108
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7832
Practice Address - Country:US
Practice Address - Phone:908-266-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist