Provider Demographics
NPI:1972337640
Name:DOUGLAS, ALIJAH DEJON CHINUA
Entity type:Individual
Prefix:
First Name:ALIJAH
Middle Name:DEJON CHINUA
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 W MARKET ST STE B5A
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1009
Mailing Address - Country:US
Mailing Address - Phone:216-256-6533
Mailing Address - Fax:
Practice Address - Street 1:733 W MARKET ST STE B5A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1009
Practice Address - Country:US
Practice Address - Phone:216-256-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health