Doctor Name: | DR. BLANCHE DAW DOUGLAS |
NPI Number: | 1053518902 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD., LPC |
License Number: | 4219 |
Business Practice Address: | 10 Wade Hampton Dr Beaufort, SC - 299071912 |
Business Phone Number: | 8435256313 |
Business Fax Number: | |
Mailing Address: | 10 Wade Hampton Dr, BEAUFORT |
State: | SC |
Postal Code: | 299071912 |
Phone Number: | 8435256313 |
Fax Number: | |
NPI Enumeration Date: | 07/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 4219 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |