Provider Demographics
NPI:1316781123
Name:DOUGLAS, CAROLINE (LMHC)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12529 YELLOW BLUFF RD STE 6/ #310
Mailing Address - Street 2:UNIT 310
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226
Mailing Address - Country:US
Mailing Address - Phone:904-608-9373
Mailing Address - Fax:
Practice Address - Street 1:3867 HAMMOCK BLUFF DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-4607
Practice Address - Country:US
Practice Address - Phone:904-608-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health