Provider Demographics
NPI:1801586094
Name:DOUGHTON, DEANNA HOLLY (LSW)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:HOLLY
Last Name:DOUGHTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5373 N UNION BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2053
Mailing Address - Country:US
Mailing Address - Phone:719-300-5735
Mailing Address - Fax:
Practice Address - Street 1:5373 N UNION BLVD STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2053
Practice Address - Country:US
Practice Address - Phone:719-300-5735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009924621104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker