Doctor Name: | MS. CARRIE E DAUGHERTY |
NPI Number: | 1013194166 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FAODP |
License Number: | |
Business Practice Address: | 12501 Hamilton Ave Highland Park, MI - 482033243 |
Business Phone Number: | 3138651580 |
Business Fax Number: | 3138651582 |
Mailing Address: | 12501 Hamilton Ave, HIGHLAND PARK |
State: | MI |
Postal Code: | 482033243 |
Phone Number: | 3138651580 |
Fax Number: | 3138651582 |
NPI Enumeration Date: | 01/30/2008 |
NPI Last Update Date: | 01/30/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |