Provider Demographics
NPI:1235763632
Name:MCDOUGAL LOGALBO, AMBER LEA (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LEA
Last Name:MCDOUGAL LOGALBO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39060 W CUSIC CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-4950
Mailing Address - Country:US
Mailing Address - Phone:304-533-5123
Mailing Address - Fax:
Practice Address - Street 1:39060 W CUSIC CT
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-4950
Practice Address - Country:US
Practice Address - Phone:304-533-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15350104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker