Alton Keith Daugherty, LCDC III

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

161525 Issued in OH

Practice address

200 Daruma Pkwy
Moraine, OH 45439-7909

Phone

(937) 963-5522

Fax

(937) 496-5216

NPI assigned

Feb 14, 2018

Last updated

Feb 14, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518566400000",
    "number": "1770083982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1470 VERNON DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454064752",
            "telephone_number": "937-416-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 DARUMA PKWY",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454397909",
            "telephone_number": "937-963-5522",
            "fax_number": "937-496-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "ALTON",
        "middle_name": "KEITH",
        "credential": "LCDC III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-14",
        "last_updated": "2018-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "161525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Cusumano
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• Charles D'Imperio, PHARMD RPH
• Helga S. Daftarian, DO, MPH, MBA
• Sarah Elizabeth Dalton
• Nicholia Davenport
• Geoffrey Davis
• Jacqueline June Davis, NURSE PRACTITIONER
• Karla Latasha Davis
• Kunita Eileen Davis, LPN

• Addiction (Substance Use Disorder) Counselor in Moraine, OH
• Providers in Moraine, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.