John Dougherty

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

License

1094 Issued in NC

Practice address

108 W Firetower Rd Ste D
Winterville, NC 28590-8408

Phone

(252) 830-3300

Fax

(252) 830-3322

NPI assigned

Mar 23, 2007

Last updated

Oct 17, 2013By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1881711026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 W FIRETOWER RD STE D",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285908408",
            "telephone_number": "252-830-3300",
            "fax_number": "252-830-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W FIRETOWER RD STE D",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285908408",
            "telephone_number": "252-830-3300",
            "fax_number": "252-830-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "JOHN",
        "name_prefix": "Prof.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NC",
            "license": "1094",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "411",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dixon Social Interactive Services Inc
• Ta'Nishia Jones Dixon, M.S.
• Kyle Dombach, PHARM.D.
• Denise K Donica, OT
• Dontaes House, LLC
• Michael Doughtie, LPC
• Dove United Counseling and Assessment Services
• Dr Kaitlyn Spencer DMD PLLC (Beacon Dental)
• Domika Dunn
• East Carolina University (ECU Pediatrics Family Autism Center)

• Intellectual & Developmental Disabilities Psychologist in Winterville, NC
• Providers in Winterville, NC by specialty
• Intellectual & Developmental Disabilities Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; 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.