Healthcare Provider Details

I. General information

NPI: 1891001970
Provider Name (Legal Business Name): ALLISON DANIELLE DOUGHERTY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 10/18/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8062 ORTONVILLE RD
CLARKSTON MI
48348-4456
US

IV. Provider business mailing address

8040 ORTONVILLE RD STE A
CLARKSTON MI
48348-4468
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-2970
  • Fax:
Mailing address:
  • Phone: 248-303-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1371973
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401009500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: