Provider Demographics
NPI:1497110464
Name:PHARES, DOUGLAS (LPCA, MA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:PHARES
Suffix:
Gender:M
Credentials:LPCA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 COLONIAL GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1200
Mailing Address - Country:US
Mailing Address - Phone:980-233-1746
Mailing Address - Fax:
Practice Address - Street 1:119 WEST AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-4332
Practice Address - Country:US
Practice Address - Phone:704-630-6634
Practice Address - Fax:866-828-5520
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12097101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)