Provider Demographics
NPI:1538334982
Name:DOUGHERTY, ANN MARIE (MS)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 200743
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2017
Mailing Address - Country:US
Mailing Address - Phone:770-386-3777
Mailing Address - Fax:770-516-4369
Practice Address - Street 1:317 GRASSDALE RD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2017
Practice Address - Country:US
Practice Address - Phone:770-386-3777
Practice Address - Fax:770-516-4369
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional