Provider Demographics
NPI:1285378869
Name:DOUGLAS, KRIS C P (LCSW)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:C P
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DUNAWAY DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-5143
Mailing Address - Country:US
Mailing Address - Phone:207-324-7955
Mailing Address - Fax:207-490-1824
Practice Address - Street 1:5 DUNAWAY DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-5143
Practice Address - Country:US
Practice Address - Phone:207-324-7955
Practice Address - Fax:207-490-1824
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC237671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical