Provider Demographics
NPI:1871776518
Name:DOUGHTY, ANNE V (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:V
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2455
Mailing Address - Country:US
Mailing Address - Phone:630-379-9881
Mailing Address - Fax:
Practice Address - Street 1:415 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2455
Practice Address - Country:US
Practice Address - Phone:630-379-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional