Provider Demographics
NPI:1689345993
Name:MCDOUGALD, KHADEJAH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KHADEJAH
Middle Name:
Last Name:MCDOUGALD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 HARBERSON RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1117
Mailing Address - Country:US
Mailing Address - Phone:443-422-5095
Mailing Address - Fax:
Practice Address - Street 1:4200 EDMONDSON AVE STE 202A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1614
Practice Address - Country:US
Practice Address - Phone:667-205-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23645104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty