Provider Demographics
NPI:1871939777
Name:DOUGHERTY, CHRISTOPHER E (LPCC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:E
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 SPURGEON ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6927
Mailing Address - Country:US
Mailing Address - Phone:937-371-3892
Mailing Address - Fax:
Practice Address - Street 1:131 OAK MEADOW DR # 102
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9812
Practice Address - Country:US
Practice Address - Phone:614-835-6068
Practice Address - Fax:614-524-0428
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE110310101YM0800X
GALPC012508101YP2500X
OHE.1100310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074861OtherMEDICAID LEGACY NUMBER CHEMICAL DEPENDECY
OH0213234Medicaid
OH0074946OtherMEDICAID LEGACY NUMBER MENTAL HEALTH
OH0074861Medicaid
OH0074946Medicaid
OHH130910OtherMEDICARE GROUP PTAN NUMBER