Provider Demographics
NPI:1689101040
Name:WINTER, DOUGLAS CHARLES (LASAC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:WINTER
Suffix:
Gender:M
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3104
Mailing Address - Country:US
Mailing Address - Phone:928-776-8251
Mailing Address - Fax:
Practice Address - Street 1:214 N ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3104
Practice Address - Country:US
Practice Address - Phone:928-776-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-15193101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)