Individual
ACQUINNETTA DOUGHTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
490 W 23RD AVE, GARY, IN 46407-3017
(219) 333-7619
Mailing address
490 W 23RD AVE, GARY, IN 46407-3017
(219) 333-7619
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000707A
IN
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAC87000707A
IN
Other
Enumeration date
10/29/2015
Last updated
06/04/2024
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