Provider Demographics
NPI:1356999296
Name:DOUGLAS, TOTIYANA (MSS, LSW)
Entity type:Individual
Prefix:
First Name:TOTIYANA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 OLD FORGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-5426
Mailing Address - Country:US
Mailing Address - Phone:302-319-4661
Mailing Address - Fax:
Practice Address - Street 1:256 CHAPMAN RD STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5415
Practice Address - Country:US
Practice Address - Phone:302-319-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker