Individual
MR. CHRISTOPHER E DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
2318 SPURGEON ST, WAYCROSS, GA 31501-6927
(937) 371-3892
Mailing address
2318 SPURGEON ST, WAYCROSS, GA 31501-6927
(937) 371-3892
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
E110310
OH
101YP2500X
Professional Counselor
Primary
E.1100310
OH
101YP2500X
Professional Counselor
LPC012508
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
MEDICAID LEGACY NUMBER CHEMICAL DEPENDECY
OH
05
—
0074861
—
OH
01
—
0074946
MEDICAID LEGACY NUMBER MENTAL HEALTH
OH
05
—
0074946
—
OH
05
—
0213234
—
OH
01
—
H130910
MEDICARE GROUP PTAN NUMBER
OH
Enumeration date
05/17/2013
Last updated
05/06/2025
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