Provider Demographics
NPI:1558755132
Name:DOUB, MARY ELIZABETH (LPC, LCAS-A, NCC)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:
Last Name:DOUB
Suffix:
Gender:F
Credentials:LPC, LCAS-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7670 N POINT CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3336
Mailing Address - Country:US
Mailing Address - Phone:367-946-8773
Mailing Address - Fax:
Practice Address - Street 1:7670 N POINT CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-794-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22449101YA0400X
NC11349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)