Provider Demographics
NPI:1053518902
Name:DOUGLAS, BLANCHE DAW (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:BLANCHE
Middle Name:DAW
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WADE HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1912
Mailing Address - Country:US
Mailing Address - Phone:843-525-6313
Mailing Address - Fax:
Practice Address - Street 1:10 WADE HAMPTON DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1912
Practice Address - Country:US
Practice Address - Phone:843-525-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health