Healthcare Provider Details

I. General information

NPI: 1457013245
Provider Name (Legal Business Name): ROBERT DOUGLAS M.ED., NCC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 WELLNESS CENTER DR
CLANTON AL
35045-2377
US

IV. Provider business mailing address

272 WELLNESS CENTER DR
CLANTON AL
35045-2377
US

V. Phone/Fax

Practice location:
  • Phone: 205-280-7733
  • Fax: 205-280-7737
Mailing address:
  • Phone: 205-280-7733
  • Fax: 205-280-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: