Healthcare Provider Details

I. General information

NPI: 1356920284
Provider Name (Legal Business Name): AMANDA RUTH DOUGHERTY CADCII, QMHA, CGAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E 11TH AVE
EUGENE OR
97401-3246
US

IV. Provider business mailing address

341 E 12TH AVE
EUGENE OR
97401-3212
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-1641
  • Fax:
Mailing address:
  • Phone: 541-683-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24-01-20380
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24-QMHA-I-004720
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: