Provider Demographics
NPI:1891747556
Name:OWEN, DOUGLAS MICHAEL (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:OWEN
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 JUDGES RD
Mailing Address - Street 2:UNIT E
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3651
Mailing Address - Country:US
Mailing Address - Phone:910-792-9888
Mailing Address - Fax:910-792-9883
Practice Address - Street 1:311 JUDGES RD
Practice Address - Street 2:UNIT E
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3651
Practice Address - Country:US
Practice Address - Phone:910-792-9888
Practice Address - Fax:910-792-9883
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4782101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102894Medicaid