Provider Demographics
NPI:1912693383
Name:DOHERTY, SUNNY DAVIS (LSWAIC)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:DAVIS
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:SONDRA
Other - Middle Name:MARIE
Other - Last Name:DOHERTY/DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13500 SE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-6909
Mailing Address - Country:US
Mailing Address - Phone:360-699-2244
Mailing Address - Fax:
Practice Address - Street 1:13500 SE 7TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6909
Practice Address - Country:US
Practice Address - Phone:360-699-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61386513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker