Doctor Name: | MARCIA N DOUGLAS |
NPI Number: | 1265474381 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW R |
License Number: | 052112 |
Business Practice Address: | 106 S Perry St Ste 4 Watkins Glen, NY - 148911615 |
Business Phone Number: | 6075358282 |
Business Fax Number: | 6075358284 |
Mailing Address: | 272 S Lhommedieu St, MONTOUR FALLS |
State: | NY |
Postal Code: | 148659786 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 052112 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |