Provider Demographics
NPI:1548535438
Name:DOUGLASS, NANCY L (MA, LPC, LCADC, NCC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:MA, LPC, LCADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 W PORTAL RD
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08802-1136
Mailing Address - Country:US
Mailing Address - Phone:908-391-2859
Mailing Address - Fax:
Practice Address - Street 1:191 W PORTAL RD
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:NJ
Practice Address - Zip Code:08802-1136
Practice Address - Country:US
Practice Address - Phone:908-391-2859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00443300101YP2500X
NJ37LC00185300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)