NICOLE LEE DOUGLAS (NPI# 1154956829) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154956829 |
| Entity Type | Individual |
| Full Name | NICOLE LEE DOUGLAS |
| Credential | ASSOCIATE MFT |
| Practice Address |
3434 Mendocino Ave # A Santa Rosa CA 95403-2274 |
| Mailing Address |
1757 Avila Ranch Dr Petaluma CA 94954-8522 |
| Practice Telephone | 7072841978 |
| Mailing Telephone | 4158238647 |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-03-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
112167 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952874299 | Nicole Douglas | Speech-Language Pathologist | 32150 N North Foothills Dr, Phoenix, AZ 85085-8100 | 2019-01-09 |
| 1336695303 | Nicole Douglas | Counselor | 40 Holland St, Somerville, MA 02144-2705 | 2016-08-30 |
| 1700257268 | Nicole Douglas | Registered Nurse | 2500 Mcclellan Ave, Suite 300, Pennsauken, NJ 08109-4613 | 2015-10-09 |
| 1699054239 | Nicole Tiffany Douglas | Speech-Language Pathologist | 185 Charlois Blvd, Winston Salem, NC 27103-1521 | 2011-08-14 |
| 1992092118 | Nicole Douglas | Counselor | 109 W Watauga Ave, Johnson City, TN 37604-5621 | 2011-07-08 |
| 1346462447 | Nicole Douglas | Speech-Language Pathologist | 400 W 14th Ave, Amarillo, TX 79101-4140 | 2007-05-02 |
| Street Address |
3434 MENDOCINO AVE # A |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95403-2274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639617699 | Sonoma County Child & Family Counseling, Inc. | Marriage & Family Therapist | 3434 Mendocino Ave # A, Santa Rosa, CA 95403-2274 | 2017-02-09 |
| 1659837912 | Eric William Gronley II | Marriage & Family Therapist | 3434 Mendocino Ave # A, Santa Rosa, CA 95403-2274 | 2019-02-12 |
| 1689160012 | Katherine Ellen Butler | Counselor | 3434 Mendocino Ave # A, Santa Rosa, CA 95403-2274 | 2018-07-09 |
| 1689195216 | Sonoma County Child & Family Counseling, Inc. | Community/Behavioral Health | 3434 Mendocino Ave # A, Santa Rosa, CA 95403-2274 | 2017-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912549841 | Abundance Acupuncture Healing Clinic | Acupuncturist | 3410 Mendocino Avenue, Santa Rosa, CA 95403 | 2019-10-11 |
| 1982161337 | Crystal J Ward | Registered Nurse | 2350 Mendocino Ave, Ste A4, Santa Rosa, CA 95403 | 2019-02-21 |
| 1033674379 | George Edward Griese | Respiratory Therapist, Registered | 501 Bicentennial Way, Santa Rosa, CA 95403 | 2019-01-31 |
| 1508320672 | East-west Natural Medicine Inc. | Acupuncturist | 2200 Range Ave #207, Santa Rosa, CA 95403 | 2019-01-23 |
| 1316410640 | Lionel C Cooper | Counselor | 315 Mark West Springs Road, Santa Rosa, CA 95403 | 2019-01-09 |
| 1326519182 | Jkb Solutions Inc. | In Home Supportive Care | 3554 Round Barn Boulevard, Suite 311, Santa Rosa, CA 95403 | 2018-12-05 |
| 1487121265 | Catholic Charities of The Diocese of Santa Rosa | Clinic/Center | 987 Airway Ct, Santa Rosa, CA 95403 | 2018-10-30 |
| 1447746524 | Lisa Jean Quang | Optometrist | 3925 Old Redwood, Medical Office Building 4, Suite 141, Santa Rosa, CA 95403 | 2018-07-02 |
| 1598253353 | Jennifer Renee Lummus | Community Health Worker | 3614 Condo Court, Santa Rosa, CA 95403 | 2018-04-27 |
| 1871042366 | Sadie Thuet | Marriage & Family Therapist | 3434 A Mendocino Ave, Santa Rosa, CA 95403 | 2016-09-26 |
| Find all providers in zip 95403 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442217 | David Lee Dutton | Counselor | 201 S. E Street, Santa Rosa, CA 95404 | 2020-09-16 |
| 1730710260 | Harold Joseph Bahr | Counselor | 1550 N Dutton Ave, Santa Rosa, CA 95401-4601 | 2020-02-03 |
| 1801432398 | William Carroll | Counselor | 1260 N Dutton Ave Ste 185, Santa Rosa, CA 95401-7146 | 2019-11-20 |
| 1497390462 | Emily Sue Hamp | Counselor | 1202 Woodlake Dr, Santa Rosa, CA 95405-9217 | 2019-11-13 |
| 1316410640 | Lionel C Cooper | Counselor | 315 Mark West Springs Road, Santa Rosa, CA 95403 | 2019-01-09 |
| 1174005540 | Amal Saeed Ahmed | Counselor | 2908 Bay Village Cir Apt 2108, Santa Rosa, CA 95403-3611 | 2018-09-03 |
| 1114436060 | Lacey Lynn Palmer | Counselor | 341 Irwin Lane, Santa Rosa, CA 95401 | 2017-09-22 |
| 1992223192 | Jill Mcculloch | Counselor | 300 Stony Point Rd Apt 190, Santa Rosa, CA 95401-5960 | 2017-09-07 |
| 1497299325 | Janice Anne Myers | Counselor | 3746 Oregon Dr, Santa Rosa, CA 95405-7136 | 2016-12-12 |
| 1689128001 | Wakanda Rose | Counselor | 254 Brey Rd, Santa Rosa, CA 95409-5556 | 2016-08-15 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95403 |
Please comment or provide details below to improve the information on NICOLE LEE DOUGLAS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.