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General NPI Number Information
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NPI Number | 1831084193
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Entity Type | Individual
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Provider Name | ROBERT EDWARD DOUGLAS II LMFT. LPC
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Gender | Male
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 115 FRANKLIN AVE
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City | FAIRVIEW
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State | NJ
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Zip | 07022-1009
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Country | US
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Telephone | 901-628-1843
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Fax |
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Provider Business Mailing Address
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Address Line | 115 FRANKLIN AVE
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City | FAIRVIEW
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State | NJ
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Zip | 07022-1009
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Country | US
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Telephone | 901-628-1843
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37FI00243000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC01157100
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License Number State | NJ
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