Individual
JIMMY DOUGLAS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9191 CARRIAGE HOUSE LN, COLUMBIA, MD 21045-4077
(512) 554-4375
Mailing address
9191 CARRIAGE HOUSE LN, COLUMBIA, MD 21045-4077
(512) 554-4375
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC11605
MD
101YP2500X
Professional Counselor
LGP8560
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38-3876389
—
MD
Enumeration date
08/22/2018
Last updated
03/06/2023
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