Provider Demographics
NPI:1528604295
Name:DOUGHTY, PATRICIA ANN (MSW, LICSW-PIP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:MSW, LICSW-PIP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:FOSTERS
Mailing Address - State:AL
Mailing Address - Zip Code:35463-0342
Mailing Address - Country:US
Mailing Address - Phone:833-484-2878
Mailing Address - Fax:
Practice Address - Street 1:2123 9TH ST STE 114
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2364
Practice Address - Country:US
Practice Address - Phone:833-484-2878
Practice Address - Fax:833-484-2878
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3803C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty