Tyneisha Donisha Douglas, CLINICAL SOCIAL WORK

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW007607 Issued in GA

Practice address

2274 Salem Road SE
Suite 106
Conyers, GA 30013

Phone

(404) 631-7716

NPI assigned

Mar 17, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Tyneisha Donisha King Former name

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 and National Provider Directory roles.

• Douglas Counseling, Coaching, & Consulting, LLC

  • Clinical Social Worker
  • Conyers, GA
  • NPI 1003546904
  NPD
• Transitional Family Services

  • Community/Behavioral Health Agency
  • Atlanta, GA
  • NPI 1023451374
  NPD (past)

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

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1841683737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2274 SALEM RD SE STE 106-1409",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132097",
            "telephone_number": "470-331-4654",
            "fax_number": "404-745-0807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2274 SALEM ROAD SE",
            "address_2": "SUITE 106",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "30013",
            "telephone_number": "404-631-7716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "TYNEISHA",
        "middle_name": "DONISHA",
        "credential": "CLINICAL SOCIAL WORK",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-17",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC200002835",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "TPSW1094",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW007607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TYNEISHA",
            "last_name": "KING",
            "middle_name": "DONISHA",
            "credential": "CLINICAL SOCIAL WORK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel M Donato, MD
• Erika Dorsey, NP
• Douglas B. Torbush Ddspc
• Douglas Counseling, Coaching, & Consulting, LLC
• Lisa Douglas, PHARM.D.
• Deirdre Dolan Douglass, P.T.
• Jamyah Douglass
• Phyllis Burr Dove-Edwin
• Jessica Ming-Chu Doyle, MD
• Dr Transport LLC

• Clinical Social Worker in Conyers, GA
• Providers in Conyers, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.