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Provider Information for 1497913073


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Mr. FULANI AREKA DOUGHTY LPC, NCC, CRC, CAADC


Sex: Male

NPI: 1497913073
Last Updated: 2013-08-29
Certification Date:

Details

NameValue
NPI1497913073
Enumeration Date2008-05-29
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address PO BOX 72
WASHINGTON, GA 30673-0072
United States

Phone: 706-678-5667 | Fax:888-495-7489
 
Primary Practice Address 311 SPRING ST
WASHINGTON, GA 30673-1717
United States

Phone: 706-678-2384 | Fax:888-495-7489
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDGA201821286B
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalGALPC005251
No 101YA0400X - Counselor - Addiction (Substance Use Disorder)GAC0153