Provider Demographics
NPI:1962723429
Name:DOUGLAS, KAREN L (LCADC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1625
Mailing Address - Country:US
Mailing Address - Phone:973-452-8566
Mailing Address - Fax:188-829-1727
Practice Address - Street 1:253 18TH AVENUE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504
Practice Address - Country:US
Practice Address - Phone:973-452-8566
Practice Address - Fax:188-291-1727
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD68014247354662101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)