Provider Demographics
NPI:1053146142
Name:DOUGHERTY, LADINA M
Entity type:Individual
Prefix:
First Name:LADINA
Middle Name:M
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 FERRY ST SE STE 3
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3751
Mailing Address - Country:US
Mailing Address - Phone:971-707-4673
Mailing Address - Fax:
Practice Address - Street 1:544 FERRY ST SE STE 3
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3751
Practice Address - Country:US
Practice Address - Phone:971-707-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor