Provider Demographics
NPI:1295395481
Name:DOUGAL, CORNELL
Entity Type:Individual
Prefix:
First Name:CORNELL
Middle Name:
Last Name:DOUGAL
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 1:3026 PINEVIEW CT NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1617
Mailing Address - Country:US
Mailing Address - Phone:570-637-3515
Mailing Address - Fax:
Practice Address - Street 1:3026 PINEVIEW CT NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1617
Practice Address - Country:US
Practice Address - Phone:570-637-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician