Provider Demographics
NPI:1508918822
Name:DUKE, DOUGLAS WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:DUKE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:52 HOOD PL
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-7902
Mailing Address - Country:US
Mailing Address - Phone:706-769-1718
Mailing Address - Fax:706-769-4535
Practice Address - Street 1:1030 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6004
Practice Address - Country:US
Practice Address - Phone:706-769-1718
Practice Address - Fax:706-769-4535
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional