Provider Demographics
NPI:1609054774
Name:DOUGHERTY, WILLIAM JAMES (LPC, LCADC, CAADC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:LPC, LCADC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 FREEMANSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5107
Mailing Address - Country:US
Mailing Address - Phone:610-762-2428
Mailing Address - Fax:610-252-5619
Practice Address - Street 1:3504 FREEMANSBURG AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:PA
Practice Address - Zip Code:18045-5107
Practice Address - Country:US
Practice Address - Phone:610-762-2428
Practice Address - Fax:610-252-5619
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00137600101YA0400X
NJ37PC00408700101YP2500X
PAPC006310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)