| Doctor Name: | ANDREA DOUGLAS |
| NPI Number: | 1033510375 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | |
| Business Practice Address: | 2711 W 15th St Panama City, FL - 324011366 |
| Business Phone Number: | 8507696001 |
| Business Fax Number: | |
| Mailing Address: | 201 Crescent Dr, DOTHAN |
| State: | AL |
| Postal Code: | 363032910 |
| Phone Number: | 3347912576 |
| Fax Number: | |
| NPI Enumeration Date: | 09/05/2014 |
| NPI Last Update Date: | 09/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |