Provider Demographics
NPI:1770714503
Name:DOUBLER, CAROL JOY (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JOY
Last Name:DOUBLER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11634 EMERALD EDGE PL
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-4515
Mailing Address - Country:US
Mailing Address - Phone:440-212-2761
Mailing Address - Fax:
Practice Address - Street 1:11634 EMERALD EDGE PL
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-4515
Practice Address - Country:US
Practice Address - Phone:440-212-2761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 0900013104100000X
OH1.0900013-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker