Provider Demographics
NPI:1114192549
Name:DOUGLAS, KARI LINAE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:LINAE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E GAYLORD AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-1604
Mailing Address - Country:US
Mailing Address - Phone:419-342-2265
Mailing Address - Fax:
Practice Address - Street 1:788 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1921
Practice Address - Country:US
Practice Address - Phone:419-756-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-27
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00296301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical