Provider Demographics
NPI:1396221560
Name:DOUGLAS, JULIA R (RAT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:RAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-3241
Mailing Address - Country:US
Mailing Address - Phone:619-236-9492
Mailing Address - Fax:
Practice Address - Street 1:2970 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3241
Practice Address - Country:US
Practice Address - Phone:619-236-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1311320618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)