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General NPI Number Information
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NPI Number | 1487315115
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Entity Type | Individual
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Provider Name | GEORLEENA ELSIE DOUGLAS LCMHC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 8406 SIX FORKS RD STE 104
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City | RALEIGH
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State | NC
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Zip | 27615-3075
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Country | US
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Telephone | 919-642-4857
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746465
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City | ATLANTA
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State | GA
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Zip | 30374-6465
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Country | US
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Telephone | 855-234-7483
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC01168200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A17187
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17187
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License Number State | NC
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