Jimmy Douglas II

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC11605 Issued in MD

Practice address

9191 Carriage House LN
Columbia, MD 21045-4077

Phone

(512) 554-4375

NPI assigned

Aug 22, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• To Become One Counseling, LLC

  • Professional Counselor
  • Columbia, MD
  • NPI 1518667849
  NPD Authorized official

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1831670405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9191 CARRIAGE HOUSE LN",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454077",
            "telephone_number": "512-554-4375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9191 CARRIAGE HOUSE LN",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454077",
            "telephone_number": "512-554-4375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 N Howard St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212185909",
            "country_code": "US",
            "telephone_number": "443-438-6742",
            "fax_number": "443-773-5624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JIMMY",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-22",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LGP8560",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC11605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38-3876389",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandrea Dougherty
• Barbara Dougherty, LCSW-C
• Grace Elizabeth Dougherty
• Maura Dougherty, BCBA
• Tiana Lynnette Douglas Goeins
• Mary Douglas
• Tia Douglas
• Kathleen M Douglass, M.A., LCPC
• Dina Douty
• Kendall Douville

• Professional Counselor in Columbia, MD
• Providers in Columbia, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; 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.