Healthcare Provider Details

I. General information

NPI: 1831797232
Provider Name (Legal Business Name): ALLISON DOUGHERTY, MA, LPC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/18/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 ORTONVILLE RD STE A
CLARKSTON MI
48348-4468
US

IV. Provider business mailing address

8040 ORTONVILLE RD STE A
CLARKSTON MI
48348-4468
US

V. Phone/Fax

Practice location:
  • Phone: 248-303-3033
  • Fax:
Mailing address:
  • Phone: 248-303-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALLISON DOUGHERTY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 248-303-3033