Provider Demographics
NPI:1295950640
Name:DOUGLAS, CAROLE ROBINSON (LCPC)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:ROBINSON
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 ROCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5733
Mailing Address - Country:US
Mailing Address - Phone:410-486-1345
Mailing Address - Fax:
Practice Address - Street 1:300 E LOMBARD ST STE 840
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3231
Practice Address - Country:US
Practice Address - Phone:410-554-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9204101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health