Individual
NICOLE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
40 HOLLAND ST, SOMERVILLE, MA 02144-2705
(617) 629-6180
(617) 629-6041
Mailing address
40 HOLLAND ST, SOMERVILLE, MA 02144-2705
(176) 629-6180
(617) 629-6041
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
11116
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/30/2016
Last updated
08/19/2019
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