Provider Demographics
NPI:1215624598
Name:DAUGHERTY, ANJANETTE (MS, LPC, LMHC)
Entity type:Individual
Prefix:
First Name:ANJANETTE
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MS, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 PALM DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2731
Mailing Address - Country:US
Mailing Address - Phone:727-324-3149
Mailing Address - Fax:
Practice Address - Street 1:1769 PALM DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2731
Practice Address - Country:US
Practice Address - Phone:727-324-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21879101YM0800X
ORC2934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional