Individual ProviderSade L DouglasCounselorBehavioral Health & Social Service ProvidersPractice Address504 Dudley St, Roxbury, MA 02119-2732(617) 445-6655PECOS EnrollmentBased on the most recent information from CMS, provider Sade L Douglas does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1174220172Provider TypeIndividualFull NameDouglas, Sade LGenderFemaleSole ProprietorYesEnumeration Date2/9/2023Last Updated2/9/2023Contact InformationPractice LocationPractice Address504 Dudley St, Roxbury, MA 02119-2732Phone(617) 445-6655FaxUnlisted FaxMailing LocationMailing Address504 Dudley St, Roxbury, MA 02119-2732PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense228615Massachusetts