Provider Demographics
NPI:1275086605
Name:DOUGHTY, NADINE MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:MARIE
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 N HANCOCK AVE STE 5N
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2672
Mailing Address - Country:US
Mailing Address - Phone:719-985-0551
Mailing Address - Fax:719-632-6458
Practice Address - Street 1:1426 N HANCOCK AVE STE 5N
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2672
Practice Address - Country:US
Practice Address - Phone:719-985-0551
Practice Address - Fax:719-632-6458
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health