Provider Demographics
NPI:1376550541
Name:DOHENY, JOHN THOMAS III (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:DOHENY
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 13TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3844
Mailing Address - Country:US
Mailing Address - Phone:706-575-1833
Mailing Address - Fax:706-565-0556
Practice Address - Street 1:1661 13TH ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3844
Practice Address - Country:US
Practice Address - Phone:706-575-1833
Practice Address - Fax:706-324-2088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACERTIFICATION #12786101YA0400X
GA003696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
141934451OtherFEDERAL TAX I.D.
GA746440550AMedicaid