Provider Demographics
NPI:1235268780
Name:KNAPP, DOUGLAS W (ICADC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:W
Last Name:KNAPP
Suffix:
Gender:M
Credentials:ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2606
Mailing Address - Country:US
Mailing Address - Phone:228-388-3942
Mailing Address - Fax:
Practice Address - Street 1:450 E PASS RD STE 3
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3212
Practice Address - Country:US
Practice Address - Phone:228-604-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS005R91K101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)