Provider Demographics
NPI:1548302730
Name:DOUGHERTY, DANIEL JOSEPH (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 FREDONIA RD
Mailing Address - Street 2:GARDEN COTTAGE COUNSELING
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1533
Mailing Address - Country:US
Mailing Address - Phone:804-264-3047
Mailing Address - Fax:804-264-3047
Practice Address - Street 1:8203 FREDONIA RD
Practice Address - Street 2:GARDEN COTTAGE COUNSELING
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1533
Practice Address - Country:US
Practice Address - Phone:804-264-3047
Practice Address - Fax:804-264-3047
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040021801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA263148-000OtherMAGELLAN
VA110311OtherANTHEM
VA4945131OtherVIRGINIA PREMIER
VA7110641OtherMAMSI
VA085692OtherSENTARA
VA800001306OtherMEDICARE