Provider Demographics
NPI:1124359393
Name:DOUGLAS, MARY ABIGAIL (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ABIGAIL
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 VILLAGE CREEK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4841
Mailing Address - Country:US
Mailing Address - Phone:469-436-9795
Mailing Address - Fax:
Practice Address - Street 1:5309 VILLAGE CREEK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4841
Practice Address - Country:US
Practice Address - Phone:469-436-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist