Provider Demographics
NPI:1043948276
Name:MCDOUGAL, TIARA DANIN (MSW)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:DANIN
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 KATRINA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3515
Mailing Address - Country:US
Mailing Address - Phone:425-772-5295
Mailing Address - Fax:
Practice Address - Street 1:3000 C ST STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3975
Practice Address - Country:US
Practice Address - Phone:907-729-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker