Provider Demographics
NPI:1437324886
Name:DOUGHERTY, DANIEL R (M A)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 200743
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-9014
Mailing Address - Country:US
Mailing Address - Phone:770-386-3777
Mailing Address - Fax:770-516-4369
Practice Address - Street 1:317 GRASSDALE RD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2017
Practice Address - Country:US
Practice Address - Phone:770-386-3777
Practice Address - Fax:770-516-4369
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional