Provider Demographics
NPI:1447924949
Name:DOUGLAS, WHITTNEY ELISE
Entity type:Individual
Prefix:
First Name:WHITTNEY
Middle Name:ELISE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 TELFAIR BLVD APT G410
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4291
Mailing Address - Country:US
Mailing Address - Phone:901-573-1623
Mailing Address - Fax:
Practice Address - Street 1:4400 STAMP RD STE 208B
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6728
Practice Address - Country:US
Practice Address - Phone:301-278-7956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)