Provider Demographics
NPI:1710761622
Name:MCDOUGLE, ANGEL D (RBT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:D
Last Name:MCDOUGLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 BROYLES RD
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-5406
Mailing Address - Country:US
Mailing Address - Phone:423-508-2374
Mailing Address - Fax:423-498-9169
Practice Address - Street 1:196 BROYLES RD
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-5406
Practice Address - Country:US
Practice Address - Phone:423-508-2374
Practice Address - Fax:423-498-9169
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician