Healthcare Provider Details

I. General information

NPI: 1801334842
Provider Name (Legal Business Name): CHRISTIE DOUGLAS PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 BOBTAIL DR
SHREVEPORT LA
71129-3417
US

IV. Provider business mailing address

7005 BOBTAIL DR
SHREVEPORT LA
71129
US

V. Phone/Fax

Practice location:
  • Phone: 318-465-9539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC10435
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: