Provider Demographics
NPI:1114674322
Name:DOUGLASS, MARCY (LPC)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BEECH ST STE A
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3190
Mailing Address - Country:US
Mailing Address - Phone:717-262-3833
Mailing Address - Fax:
Practice Address - Street 1:20 BEECH ST STE A
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3190
Practice Address - Country:US
Practice Address - Phone:717-262-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC003594OtherLICENSE