Provider Demographics
NPI:1295205136
Name:MCDOUGAL, ERNEST
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WETZEL ST
Mailing Address - Street 2:
Mailing Address - City:PADEN CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26159-1817
Mailing Address - Country:US
Mailing Address - Phone:304-771-2577
Mailing Address - Fax:
Practice Address - Street 1:255 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1040
Practice Address - Country:US
Practice Address - Phone:740-695-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.168766101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)