Provider Demographics
NPI:1033149141
Name:CANTERBURY-COUNTS, WILLIAM DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:CANTERBURY-COUNTS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8445 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4409
Mailing Address - Country:US
Mailing Address - Phone:772-532-5769
Mailing Address - Fax:866-806-5244
Practice Address - Street 1:8445 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4409
Practice Address - Country:US
Practice Address - Phone:772-532-5769
Practice Address - Fax:866-806-5244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4461103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650286196OtherFEIN
FLR03970Medicare UPIN
FL650286196OtherFEIN