Provider Demographics
NPI:1861762999
Name:DOHERTY, TRICIA JANE (MS, LCPC)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:JANE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5721
Mailing Address - Country:US
Mailing Address - Phone:301-745-6687
Mailing Address - Fax:301-739-0041
Practice Address - Street 1:228 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5721
Practice Address - Country:US
Practice Address - Phone:301-745-6687
Practice Address - Fax:301-739-0041
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1465101YA0400X
MDLC4218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)