Provider Demographics
NPI:1255981197
Name:MCDOUGAL, DIARA
Entity type:Individual
Prefix:
First Name:DIARA
Middle Name:
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 HORIZON VIEW PL
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-2829
Mailing Address - Country:US
Mailing Address - Phone:301-875-2469
Mailing Address - Fax:
Practice Address - Street 1:1110 HORIZON VIEW PL
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-2829
Practice Address - Country:US
Practice Address - Phone:301-875-2469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-68213103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst