Healthcare Provider Details

I. General information

NPI: 1780886077
Provider Name (Legal Business Name): JAMES DOUGLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37437 GLENMOOR DR
FREMONT CA
94536-5731
US

IV. Provider business mailing address

247 GROVE WAY
CHERRYLAND CA
94541-2434
US

V. Phone/Fax

Practice location:
  • Phone: 510-713-3202
  • Fax:
Mailing address:
  • Phone: 510-754-7227
  • Fax: 510-713-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: