Provider Demographics
NPI:1871800151
Name:DOROUGH, CECILY ALEXANDRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:CECILY
Middle Name:ALEXANDRA
Last Name:DOROUGH
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 1:1 MILE CRSE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5525
Mailing Address - Country:US
Mailing Address - Phone:301-461-6698
Mailing Address - Fax:
Practice Address - Street 1:1 MILE CRSE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5525
Practice Address - Country:US
Practice Address - Phone:301-461-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040091601041C0700X
TX560741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical