MEDICARE: JOHN T DOHENY III LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	12786
2	101YM0800X	Mental Health Counselor	003696	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043587595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN T DOHENY III LPC

Provider Business Mailing Address
First Line	:	PO BOX 5754
Second Line	:	SUITE 41
City	:	COLUMBUS
State	:	GA
Zip	:	31906-0754
Country	:	US
Telephone Number	:	706-575-1833
Fax Number	:	706-507-9012

Provider Business Practice Location Address
First Line	:	2901 UNIVERSITY AVE
Second Line	:	SUITE 41
City	:	COLUMBUS
State	:	GA
Zip	:	31907-7606
Country	:	US
Telephone Number	:	706-575-1833
Fax Number	:	706-507-9012

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	JOHN DOHENY
Credential	:	LPC
Telephone Number	:	706-575-1833

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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