Provider Demographics
NPI:1902170947
Name:DOUGLAS, DIEPRIYE CAITLIN
Entity Type:Individual
Prefix:
First Name:DIEPRIYE
Middle Name:CAITLIN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5652
Mailing Address - Country:US
Mailing Address - Phone:281-238-0852
Mailing Address - Fax:281-238-0865
Practice Address - Street 1:5500 AVENUE N
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5652
Practice Address - Country:US
Practice Address - Phone:281-238-0852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084271-1104100000X
TX575951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker