Provider Demographics
NPI:1093933210
Name:DOUGLASS COMMUNITY ASSOCIATION
Entity Type:Organization
Organization Name:DOUGLASS COMMUNITY ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TERRENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-343-6185
Mailing Address - Street 1:1000 W PATERSON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-1710
Mailing Address - Country:US
Mailing Address - Phone:269-343-6185
Mailing Address - Fax:269-492-1749
Practice Address - Street 1:1000 W PATERSON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-1710
Practice Address - Country:US
Practice Address - Phone:269-343-6185
Practice Address - Fax:269-492-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty