Provider Demographics
NPI:1669233227
Name:DOUGLAS, SHEONA
Entity type:Individual
Prefix:
First Name:SHEONA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEONA
Other - Middle Name:
Other - Last Name:MOTSHABI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:5 JANET DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1929
Mailing Address - Country:US
Mailing Address - Phone:860-994-7890
Mailing Address - Fax:
Practice Address - Street 1:750 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2703
Practice Address - Country:US
Practice Address - Phone:203-800-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical