Provider Demographics
NPI:1962144410
Name:DOUGHTY, CHYNA C (MS, MFT)
Entity type:Individual
Prefix:
First Name:CHYNA
Middle Name:C
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 WOODSTOCK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2135
Mailing Address - Country:US
Mailing Address - Phone:770-910-2753
Mailing Address - Fax:
Practice Address - Street 1:1755 WOODSTOCK RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2135
Practice Address - Country:US
Practice Address - Phone:770-910-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist