Michele Victoria Douglass, LCSWA, LCASA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

PO21653 Issued in NC

Practice address

1740 Heritage Center Dr Ste 201
Wake Forest, NC 27587-9849

Phone

(919) 556-6501

Fax

(919) 556-4933

NPI assigned

Apr 12, 2025

Last updated

Apr 22, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bowman Family Services Inc

  • Mental Health Counselor
  • Wake Forest, NC
  • NPI 1154430155
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1720873433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 EVERS DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276104924",
            "telephone_number": "919-559-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 HERITAGE CENTER DR STE 201",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275879849",
            "telephone_number": "919-556-6501",
            "fax_number": "919-556-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "MICHELE",
        "middle_name": "VICTORIA",
        "credential": "LCSWA, LCASA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-12",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-30416",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "PO21653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Brent Dorenkamp
• Ashley Gibson Dorsey
• Katrina Dorsey, AU.D.
• Catherine V Doster, LCMHCA, NCC
• Kimberly Mark Douglas, OD
• Down to Earth Therapy, PLLC
• Dr Chaudhary DMD PLLC
• Dr. Cameron & Associates of Wake Forest I, PLLC (Triangle Pediatric Dentistry)
• Dr. Clifton Cameron & Associates of Heritage Junction, PLLC
• Dr. McClary & Assoc. Wake Forest, P.a. (DentalWorks)

• Clinical Social Worker in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.