Provider Demographics
NPI:1992167183
Name:DOUGHERTY, NAKESIA (MHA, MSW)
Entity type:Individual
Prefix:
First Name:NAKESIA
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:MHA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 CHANCELLOR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5641
Mailing Address - Country:US
Mailing Address - Phone:678-255-5924
Mailing Address - Fax:
Practice Address - Street 1:1992 CHANCELLOR RIDGE RD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5641
Practice Address - Country:US
Practice Address - Phone:678-255-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker