Provider Information for 1609054774
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WILLIAM JAMES DOUGHERTY LPC, LCADC, CAADC
Sex: Male
NPI: 1609054774
Last Updated: 2012-07-02
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1609054774 | ||||||||||||||||
| Enumeration Date | 2008-01-31 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 3504 FREEMANSBURG AVE PALMER, PA 18045-5107 United States Phone: 610-762-2428 | Fax:610-252-5619 | ||||||||||||||||
| Primary Practice Address | 3504 FREEMANSBURG AVE PALMER, PA 18045-5107 United States Phone: 610-762-2428 | Fax:610-252-5619 | ||||||||||||||||
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