Provider Demographics
NPI:1508973553
Name:DOUGLAS, DINAH MCGUIRE (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:MS
First Name:DINAH
Middle Name:MCGUIRE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4562
Mailing Address - Country:US
Mailing Address - Phone:434-972-1821
Mailing Address - Fax:434-970-1374
Practice Address - Street 1:401 4TH ST NW
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4562
Practice Address - Country:US
Practice Address - Phone:434-972-1821
Practice Address - Fax:434-970-1374
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002342101YP2500X
VA0717000690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11478117OtherCAQH