MEDICARE: MICHAEL DOUGHTIE 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	101YM0800X	Mental Health Counselor	4324	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	138UY	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	20-3675549	OTHER	NC	CHAMPUS
4	20-3675549	OTHER	NC	TAX ID

General Provider Information

NPI Number	:	1942330675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DOUGHTIE LPC

Provider Business Mailing Address
First Line	:	215 LAFOLLETTE DR
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-9088
Country	:	US
Telephone Number	:	252-402-5693
Fax Number	:	252-355-2358

Provider Business Practice Location Address
First Line	:	215 LAFOLLETTE DR
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-9088
Country	:	US
Telephone Number	:	252-402-5693
Fax Number	:	252-355-2358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/09/2007

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Directions to “ MICHAEL DOUGHTIE LPC” Practice Location

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