Provider Demographics
NPI:1982036018
Name:DOUGHERTY, THOMAS E III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:DOUGHERTY
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:TED
Other - Middle Name:
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2000 BREMO RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2440
Mailing Address - Country:US
Mailing Address - Phone:804-282-8332
Mailing Address - Fax:804-288-4558
Practice Address - Street 1:2000 BREMO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2440
Practice Address - Country:US
Practice Address - Phone:804-282-8332
Practice Address - Fax:804-288-4558
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040082171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical