Provider Demographics
NPI:1467066753
Name:MCDOUGAL, GEO'QUANA W (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:GEO'QUANA
Middle Name:W
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 KILDAIRE FARM RD STE 304
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7600
Mailing Address - Country:US
Mailing Address - Phone:919-267-1161
Mailing Address - Fax:844-748-0842
Practice Address - Street 1:1140 KILDAIRE FARM RD STE 304
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7600
Practice Address - Country:US
Practice Address - Phone:919-267-1161
Practice Address - Fax:844-748-0842
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12239A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist