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General NPI Number Information
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NPI Number | 1205670718
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Entity Type | Individual
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Provider Name | BRIANNA ELIZABETH DOUGLAS LCSWA
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Gender | Female
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1025 VINEHAVEN DR NE
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City | CONCORD
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State | NC
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Zip | 28025-2439
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Country | US
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Telephone | 704-918-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 2134 GLENWOOD ST
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City | KANNAPOLIS
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State | NC
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Zip | 28083-3043
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Country | US
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Telephone | 704-960-2331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P020760
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License Number State | NC
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