1528604295 NPI number — MRS. PATRICIA ANN DOUGHTY MSW, LICSW-PIP

Table of content: MRS. PATRICIA ANN DOUGHTY MSW, LICSW-PIP (NPI 1528604295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528604295 NPI number — MRS. PATRICIA ANN DOUGHTY MSW, LICSW-PIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUGHTY
Provider First Name:
PATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW-PIP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWRENCE
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528604295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 342
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOSTERS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35463-0342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-484-2878
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2123 9TH ST STE 114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-484-2878
Provider Business Practice Location Address Fax Number:
833-484-2878
Provider Enumeration Date:
11/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3803C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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