Healthcare Provider Details

I. General information

NPI: 1841348356
Provider Name (Legal Business Name): CORI CARTER DOUGLAS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 FREDERICA ST
OWENSBORO KY
42301-5442
US

IV. Provider business mailing address

2720 FREDERICA ST
OWENSBORO KY
42301-5442
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2484
  • Fax: 270-685-6015
Mailing address:
  • Phone: 270-926-2484
  • Fax: 270-685-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3423
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: