Daryll Elizabeth Douglas, LPC
Individual provider Active NPI Professional Counselor · Northampton, PA
NPI 1306239397 · NPPES record last updated Mar 8, 2025
Key facts
- NPI
- 1306239397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- PC010586 (PA)
- Practice address
- 233 McNair Cir
Northampton, PA 18067-9196 - Phone
- (804) 439-5115
- NPI assigned
- Mar 14, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in DC, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250407002948 | DC | Practitioner - Mental Health Counselor | 4688198062 | Reassigns benefits to 1 organization |
| I20250417001298 | VA | Practitioner - Mental Health Counselor | 4688198062 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Law
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC010586 | PA | MD | Professional Counselor |
| 0701006032 | VA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health Specialty Group PA | Professional | Current |
Accepting new patients |
| Grow Healthcare Group PA | Professional | Current |
Accepting new patients |
| Glenn R. Koch & Associates, LLC | Past | Accepting new patients | |
| Ephratah Health Group LLC | Past |
Accepting new patients | |
| Balance Behavioral Health, PLLC | Professional | Past | Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701006032 | VA | |
| Professional Counselor | 101YP2500X | PC010586 | PA | Yes |
Addresses
Primary practice location
233 McNair Cir
Northampton, PA 18067-9196
Mailing address
233 McNair Cir
Northampton, PA 18067-9196
Phone (804) 439-5115
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All providers in Northampton, PA · Professional Counselor in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.