Provider Demographics
NPI:1922710490
Name:MCDOUGALD, ZAVERY LERENZO (MSW,LCSWA)
Entity Type:Individual
Prefix:MR
First Name:ZAVERY
Middle Name:LERENZO
Last Name:MCDOUGALD
Suffix:
Gender:M
Credentials:MSW,LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5443
Mailing Address - Country:US
Mailing Address - Phone:919-208-0671
Mailing Address - Fax:
Practice Address - Street 1:511 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5443
Practice Address - Country:US
Practice Address - Phone:919-208-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0159031041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical