Provider Demographics
NPI:1427892512
Name:DOUGLAS, TRONDA (TRAINEE QMHP)
Entity type:Individual
Prefix:
First Name:TRONDA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:TRAINEE QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SUSHRUTA DR STE C
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8801
Mailing Address - Country:US
Mailing Address - Phone:681-446-7071
Mailing Address - Fax:681-446-7079
Practice Address - Street 1:1004 SUSHRUTA DR STE C
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8801
Practice Address - Country:US
Practice Address - Phone:681-446-7071
Practice Address - Fax:681-446-7079
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor