Provider Demographics
NPI:1609124569
Name:DOUGLAS, ARTHUR JR (LCSW-C)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:DOUGLAS
Suffix:JR
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 N POTOMAC ST STE 103
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-3301
Mailing Address - Country:US
Mailing Address - Phone:301-733-1500
Mailing Address - Fax:301-733-1501
Practice Address - Street 1:44 N POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4855
Practice Address - Country:US
Practice Address - Phone:240-354-6956
Practice Address - Fax:301-302-7384
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181431041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1041C0700XMedicaid
MD1942650692Medicaid