Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 193 | NC |
NPI | 1174814123 |
---|---|
Provider Name | Dr. Thomas E Dougherty JR. |
First Address | Winston Salem, NC 27103-1823 |
Second Address | Winston Salem, NC 27103-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 26/04/2011 |