Provider Demographics
NPI:1285701425
Name:PAUL, DOUGLASS (LMHC, QS, LPC)
Entity type:Individual
Prefix:
First Name:DOUGLASS
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:LMHC, QS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 HANKS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6707
Mailing Address - Country:US
Mailing Address - Phone:678-477-8747
Mailing Address - Fax:
Practice Address - Street 1:1619 HANKS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6707
Practice Address - Country:US
Practice Address - Phone:678-477-8747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17517101YM0800X
GALPC005791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH17517OtherFL BOARD OF MHC
GALPC005791OtherGA COMPOSITE BOARD