# GREG DOUGLAS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1881867182
- **Gender:** Man
- **Credential:** LISW-S, CNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | I.0700380-SUPV | OH | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | COA.17489-NP | OH | Yes |

## Other

- **Enumeration date:** 04/08/2008
- **Last updated:** 07/27/2015