Provider Demographics
NPI:1992490122
Name:DOUGLAS, GIAVANTE (LMSW)
Entity type:Individual
Prefix:
First Name:GIAVANTE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MURRAY GUARD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3610
Mailing Address - Country:US
Mailing Address - Phone:731-736-4400
Mailing Address - Fax:877-270-3514
Practice Address - Street 1:39 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3610
Practice Address - Country:US
Practice Address - Phone:731-736-4400
Practice Address - Fax:877-270-3514
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health