Provider Demographics
NPI:1982637757
Name:MCDOUGAL, SIDONNA BRIGHT (LCSW, RPT)
Entity Type:Individual
Prefix:MRS
First Name:SIDONNA
Middle Name:BRIGHT
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:LCSW, RPT
Other - Prefix:MS
Other - First Name:SIDONNA
Other - Middle Name:BRIGHT
Other - Last Name:MCDOUGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8221 SUMMA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3451
Mailing Address - Country:US
Mailing Address - Phone:423-596-0365
Mailing Address - Fax:
Practice Address - Street 1:8221 SUMMA AVE STE F
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3451
Practice Address - Country:US
Practice Address - Phone:423-596-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4132753OtherBCBS
TN4132753OtherBCBS