Provider Demographics
NPI:1700546652
Name:DOUGLASS, BRANDI MICHELLE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MICHELLE
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CHERRY BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE HOCKING
Mailing Address - State:OH
Mailing Address - Zip Code:45742-5137
Mailing Address - Country:US
Mailing Address - Phone:304-887-4799
Mailing Address - Fax:
Practice Address - Street 1:209 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2736
Practice Address - Country:US
Practice Address - Phone:263-574-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI2405337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker