Provider Demographics
NPI:1972068203
Name:MCDOUGALL, WILLIAM PAUL IV
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:MCDOUGALL
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2403
Mailing Address - Country:US
Mailing Address - Phone:415-492-0818
Mailing Address - Fax:415-492-0615
Practice Address - Street 1:2521 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2403
Practice Address - Country:US
Practice Address - Phone:415-595-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA7885203Medicaid