Provider Demographics
NPI:1639547813
Name:DOHERTY, JOSEPH (MA, LPC, CWC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:MA, LPC, CWC
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC, CWC
Mailing Address - Street 1:595 COPELAND MILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8908
Mailing Address - Country:US
Mailing Address - Phone:614-981-6172
Mailing Address - Fax:614-392-2875
Practice Address - Street 1:595 COPELAND MILL RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8908
Practice Address - Country:US
Practice Address - Phone:614-981-6172
Practice Address - Fax:614-392-2875
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health