Provider Demographics
NPI:1427199512
Name:DOUGLAS, ANEWMAY A (C19981214)
Entity Type:Individual
Prefix:PROF
First Name:ANEWMAY
Middle Name:A
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:C19981214
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2817
Mailing Address - Country:US
Mailing Address - Phone:510-547-1531
Mailing Address - Fax:510-547-1543
Practice Address - Street 1:3408 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2817
Practice Address - Country:US
Practice Address - Phone:510-547-1531
Practice Address - Fax:510-547-1543
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC19981214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)