Eric Douglass

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.150683 Issued in OH

Practice address

4977 Northcutt PL
Dayton, OH 45414-3839

Phone

(937) 387-6395

NPI assigned

Jan 20, 2019

Last updated

Sep 30, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Eric Douglass Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Nova Behavioral Health, Inc

  • Substance Abuse Rehabilitation Facility
  • Dayton, OH
  • NPI 1548217748
  NPD (past)
• Nova Behavioral Health, Inc.

  • Substance Abuse Rehabilitation Facility
  • Dayton, OH
  • NPI 1164782017
  NPD (past)

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

{
    "created_epoch": "1547942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1922572221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 FOXBORO DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454161624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4977 NORTHCUTT PL",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454143839",
            "telephone_number": "937-387-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "ERIC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-20",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.150683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIC",
            "last_name": "DOUGLASS",
            "credential": "CDCA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Allison Dougherty
• Brianah Douglas
• Danielle R Douglas, APRN
• Devon Elizabeth Douglas, PSY.D.
• Patricia Wright Douglas, LPN
• Moses Douglass
• Arianna Dover
• Irene Dow
• Jaynie Dowdy, RN
• Jennifer Denise Dowell, RN

• Addiction (Substance Use Disorder) Counselor in Dayton, OH
• Providers in Dayton, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; 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.