Provider Demographics
NPI:1063490209
Name:MCDONALD, MICHAEL (MS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 W ALEX BELL RD
Mailing Address - Street 2:PRIVATE PRACTICE
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3050
Mailing Address - Country:US
Mailing Address - Phone:937-312-1611
Mailing Address - Fax:937-312-1611
Practice Address - Street 1:548 W ALEX BELL RD
Practice Address - Street 2:PRIVATE PRACTICE
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3050
Practice Address - Country:US
Practice Address - Phone:937-312-1611
Practice Address - Fax:937-312-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional