=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578022406
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY ASHLEY DOHERTY LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2019
-----------------------------------------------------
Last Update Date | 08/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 343 RIVER OAKS DR
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48381-1037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-717-1232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 WOODRIDGE CT
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48371-5252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6801103915
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------