William James Dougherty, LPC, LCADC, CAADC
Individual provider Active NPI Professional Counselor · Palmer, PA
NPI 1609054774 · NPPES record last updated Jul 2, 2012
Key facts
- NPI
- 1609054774
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- PC006310 (PA)
- Practice address
- 3504 Freemansburg Ave
Palmer, PA 18045-5107 - Phone
- (610) 762-2428
- Fax
- (610) 252-5619
- NPI assigned
- Jan 31, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37LC00137600 | NJ | MD | Addiction (Substance Use Disorder) Counselor |
| 37PC00408700 | NJ | MD | Professional Counselor |
| PC006310 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intentional Counseling & Wellness, LLC | Professional | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 37LC00137600 | NJ | |
| Professional Counselor | 101YP2500X | 37PC00408700 | NJ | |
| Professional Counselor | 101YP2500X | PC006310 | PA | Yes |
Addresses
Primary practice location
3504 Freemansburg Ave
Palmer, PA 18045-5107
Mailing address
3504 Freemansburg Ave
Palmer, PA 18045-5107
Phone (610) 762-2428
Other providers in Palmer, PA
All providers in Palmer, PA · Professional Counselor in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.