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NPI Code Detail

MEDICARE: MS. HEATHER L DOUGLAS LCSW

MEDICARE: MS. HEATHER L DOUGLAS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC004743NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1139NVOTHERNCBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891861431
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. HEATHER L DOUGLAS LCSW
Provider Business Mailing Address
First Line : 5545 GRAFTON PL
Second Line :
City : CHARLOTTE
State : NC
Zip : 28212-3615
Country : US
Telephone Number : 704-277-7784
Fax Number :
Provider Business Practice Location Address
First Line : 360 N CASWELL RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2442
Country : US
Telephone Number : 704-375-0033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2006
Last Update Date : 03/15/2011

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