Individual
MR. EMERSON LEE DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
30800 CHAGRIN BLVD, PEPPER PIKE, OH 44124-5925
(216) 591-0324
(216) 591-1243
Mailing address
9220 MENTOR AVE, MENTOR, OH 44060-6412
(440) 354-9924
(833) 209-8465
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I.2002146
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2864093
—
OH
Enumeration date
09/24/2019
Last updated
05/05/2020
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