Individual
ALTON KEITH DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC III
Contact information
Practice address
200 DARUMA PKWY, MORAINE, OH 45439-7909
(937) 963-5522
(937) 496-5216
Mailing address
1470 VERNON DR, DAYTON, OH 45406-4752
(937) 416-9030
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
161525
OH
Other
Enumeration date
02/14/2018
Last updated
02/14/2018
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