Provider Demographics
NPI:1790019099
Name:MCDOUGAL, ERICA A (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:A
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HARLOW ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4908
Mailing Address - Country:US
Mailing Address - Phone:207-561-9533
Mailing Address - Fax:207-561-9538
Practice Address - Street 1:360 HARLOW ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4908
Practice Address - Country:US
Practice Address - Phone:207-561-9533
Practice Address - Fax:207-561-9538
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC133781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical