Provider Demographics
NPI:1952019432
Name:DOUGLAS, EILEEN KATE (PHD, LPC, ATR-BC)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:KATE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PHD, LPC, ATR-BC
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 1980
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-1980
Mailing Address - Country:US
Mailing Address - Phone:757-446-5895
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVE # 710
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005556101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor