Healthcare Provider Details

I. General information

NPI: 1891747556
Provider Name (Legal Business Name): DOUGLAS MICHAEL OWEN M.S., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 JUDGES RD UNIT E
WILMINGTON NC
28405-3651
US

IV. Provider business mailing address

311 JUDGES RD UNIT E
WILMINGTON NC
28405-3651
US

V. Phone/Fax

Practice location:
  • Phone: 910-792-9888
  • Fax: 910-792-9883
Mailing address:
  • Phone: 910-792-9888
  • Fax: 910-792-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4782
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: