Individual
DOUGLAS J. BLAINE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., LPC
Contact information
Practice address
1242 W CHESTER PIKE, SUITE 200, WEST CHESTER, PA 19382-5657
(484) 266-0084
(484) 266-0103
Mailing address
1242 W CHESTER PIKE, SUITE 200, WEST CHESTER, PA 19382-5657
(484) 266-0084
(484) 266-0103
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
PC007918
PA
101YP2500X
Professional Counselor
PC007918
PA
Other
Enumeration date
03/23/2010
Last updated
11/10/2015
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