Provider Demographics
NPI:1902275324
Name:DOUGLAS, DELVA (LCSW)
Entity Type:Individual
Prefix:
First Name:DELVA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 KILDAIRE FARM RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4597
Mailing Address - Country:US
Mailing Address - Phone:919-633-1218
Mailing Address - Fax:919-650-1420
Practice Address - Street 1:1140 KILDAIRE FARM RD STE 206
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-633-1218
Practice Address - Fax:919-650-1420
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0100351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical