Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 26686 | CA |
NPI | 1003194960 |
---|---|
Provider Name | Christine Dougherty |
First Address | Vista, CA 92084-5218 |
Second Address | Vista, CA 92084-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2011 |
Last Update Date | 17/03/2020 |