Provider Demographics
NPI:1336681493
Name:DOUGHERTY, CASSIE ROSE (LPC,MH)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:ROSE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:LPC,MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 YORKLYN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8700
Mailing Address - Country:US
Mailing Address - Phone:302-235-3398
Mailing Address - Fax:302-397-2958
Practice Address - Street 1:726 YORKLYN RD STE 120
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8700
Practice Address - Country:US
Practice Address - Phone:302-235-3398
Practice Address - Fax:302-397-2958
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health