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General NPI Number Information
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NPI Number | 1720194681
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Entity Type | Individual
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Provider Name | MELLISA GAIL DOUGLAS M.ED,LPC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 71 WILSON BLVD STE A1
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2283
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Country | US
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Telephone | 540-949-4202
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Fax | 540-886-7380
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Provider Business Mailing Address
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Address Line | 1302 BURNSVILLE RD
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City | WILLIAMSVILLE
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State | VA
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Zip | 24487-2148
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Country | US
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Telephone | 540-396-3379
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Fax | 540-886-7380
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17005
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701004135
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License Number State | VA
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