Provider Demographics
NPI:1558851923
Name:DOUGLAS, ABISHAG (LPCC, CRC, EDD)
Entity Type:Individual
Prefix:
First Name:ABISHAG
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LPCC, CRC, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4644 POWDER SPRINGS DALLAS RD UNIT 904
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-7709
Mailing Address - Country:US
Mailing Address - Phone:937-516-1957
Mailing Address - Fax:877-728-4587
Practice Address - Street 1:212 N 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1408
Practice Address - Country:US
Practice Address - Phone:937-516-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113850101YP2500X
OH2002031101YP2500X
KY265396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional