Provider Demographics
NPI:1649232208
Name:DOOLEN, MICHAEL CRAIG (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:DOOLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PRESIDENTS DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2168
Mailing Address - Country:US
Mailing Address - Phone:910-322-3925
Mailing Address - Fax:
Practice Address - Street 1:138 PRESIDENTS DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2168
Practice Address - Country:US
Practice Address - Phone:910-322-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106254Medicaid