Provider Demographics
NPI:1295202539
Name:DOUGLAS, CHRISTY LADONNA (LCMHC)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LADONNA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 KILDAIRE FARM RD STE 135
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-2278
Mailing Address - Country:US
Mailing Address - Phone:919-504-3004
Mailing Address - Fax:919-551-7446
Practice Address - Street 1:4030 WAKE FOREST RD STE 206
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6800
Practice Address - Country:US
Practice Address - Phone:919-713-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional