Provider Demographics
NPI:1801622998
Name:DOUGLAS, CALACIA TIANA (LCSW-A)
Entity type:Individual
Prefix:
First Name:CALACIA
Middle Name:TIANA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-2153
Mailing Address - Country:US
Mailing Address - Phone:910-506-4018
Mailing Address - Fax:
Practice Address - Street 1:1781 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5407
Practice Address - Country:US
Practice Address - Phone:910-406-4018
Practice Address - Fax:843-400-5045
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0195901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical