Individual
JENNIYA DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 N BROAD ST, PHILADELPHIA, PA 19102-1512
(121) 556-8086
Mailing address
112 N BROAD ST, PHILADELPHIA, PA 19102-1512
(121) 556-8086
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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