Provider Demographics
NPI:1336485325
Name:DOHERTY, ADRIENNE (LCPC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W STATE ST STE 250
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-1140
Mailing Address - Country:US
Mailing Address - Phone:815-969-8836
Mailing Address - Fax:815-969-8871
Practice Address - Street 1:308 W STATE ST STE 250
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-1140
Practice Address - Country:US
Practice Address - Phone:815-969-8836
Practice Address - Fax:815-969-8871
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012568101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional