Provider Demographics
NPI:1861832974
Name:DOUGLASS, OLLEN W (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:OLLEN
Middle Name:W
Last Name:DOUGLASS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4531
Mailing Address - Country:US
Mailing Address - Phone:410-935-6382
Mailing Address - Fax:
Practice Address - Street 1:600 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5104
Practice Address - Country:US
Practice Address - Phone:410-585-1370
Practice Address - Fax:443-378-5719
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD014491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical