Provider Demographics
NPI:1205042306
Name:DOUGLAS, ESTELLE (MS LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ESTELLE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GRANT WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1693
Mailing Address - Country:US
Mailing Address - Phone:609-279-0351
Mailing Address - Fax:718-962-2742
Practice Address - Street 1:36 GRANT WAY
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1693
Practice Address - Country:US
Practice Address - Phone:609-279-0351
Practice Address - Fax:718-962-2742
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002774-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health