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General NPI Number Information
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NPI Number | 1811697022
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Entity Type | Individual
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Provider Name | DOUGLAS DEJOURNETTE
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Gender | Male
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 1405 S SCALES ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-5634
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Country | US
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Telephone | 336-280-9432
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Fax |
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Provider Business Mailing Address
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Address Line | 2271 CHANDLER MILL RD
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City | PELHAM
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State | NC
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Zip | 27311-8777
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Country | US
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Telephone | 336-459-7310
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 10158
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License Number State | NC
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