Provider Demographics
NPI:1437612249
Name:DOUGLAS, TCHALLA
Entity Type:Individual
Prefix:
First Name:TCHALLA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29540-0607
Mailing Address - Country:US
Mailing Address - Phone:843-230-8824
Mailing Address - Fax:877-827-5681
Practice Address - Street 1:347 DOVESVILLE HWY
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29540-9366
Practice Address - Country:US
Practice Address - Phone:843-230-8824
Practice Address - Fax:877-827-5681
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency