Healthcare Provider Details

I. General information

NPI: 1447924949
Provider Name (Legal Business Name): WHITTNEY ELISE DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 STAMP RD STE 208B
TEMPLE HILLS MD
20748-6728
US

IV. Provider business mailing address

4351 TELFAIR BLVD APT G410
CAMP SPRINGS MD
20746-4291
US

V. Phone/Fax

Practice location:
  • Phone: 301-278-7956
  • Fax:
Mailing address:
  • Phone: 901-573-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: