Provider Demographics
NPI:1497913073
Name:DOUGHTY, FULANI AREKA (LPC, NCC, CRC, CAADC)
Entity Type:Individual
Prefix:MR
First Name:FULANI
Middle Name:AREKA
Last Name:DOUGHTY
Suffix:
Gender:M
Credentials:LPC, NCC, CRC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-0072
Mailing Address - Country:US
Mailing Address - Phone:706-678-5667
Mailing Address - Fax:888-495-7489
Practice Address - Street 1:311 SPRING ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1717
Practice Address - Country:US
Practice Address - Phone:706-678-2384
Practice Address - Fax:888-495-7489
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005251101YP2500X
GAC0153101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA201821286BMedicaid