| Doctor Name: | SANDRA DENISE DOUGLAS |
| NPI Number: | 1013345263 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 2049 Skyline Dr Lemon Grove, CA - 919454221 |
| Business Phone Number: | 6194657303 |
| Business Fax Number: | 6194664672 |
| Mailing Address: | 2049 Skyline Dr, LEMON GROVE |
| State: | CA |
| Postal Code: | 919454221 |
| Phone Number: | 6194657303 |
| Fax Number: | 6194664672 |
| NPI Enumeration Date: | 10/25/2013 |
| NPI Last Update Date: | 10/25/2013 |
| 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: | |