NPI 1013719152

Kenyetta S Douglass

Practitioner Peer Specialist Canton, OH

Practice location

Address: 131 Wertz Ave NW, Canton, OH 44708-4171
Phone: (234) 214-8470
Fax: (234) 214-8471
Mailing address: 131 Wertz Ave. NW, Canton, OH 44708-4171

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X Licence APS.005628 (OH)

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Registry record

NPI: 1013719152
Entity type: Individual
Sex (as registered): Female
NPI issued: 27 Mar 2025
Record last updated: 27 Mar 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.