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General NPI Number Information
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NPI Number | 1093933210
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Entity Type | Organization
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Legal Business Name | DOUGLASS COMMUNITY ASSOCIATION
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1000 W PATERSON ST
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City | KALAMAZOO
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State | MI
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Zip | 49007-1710
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Country | US
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Telephone | 269-343-6185
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Fax | 269-492-1749
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Provider Business Mailing Address
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Address Line | 1000 W PATERSON ST
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City | KALAMAZOO
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State | MI
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Zip | 49007-1710
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Country | US
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Telephone | 269-343-6185
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Fax | 269-492-1749
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TIMOTHY R TERRENTINE
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Credential |
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Telephone | 269-343-6185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 390183
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License Number State | MI
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