Provider Demographics
NPI:1770692667
Name:MCDOUGALL, EMILY AISHA (MA)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:AISHA
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 K ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5116
Mailing Address - Country:US
Mailing Address - Phone:916-204-3083
Mailing Address - Fax:
Practice Address - Street 1:2617 K ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5116
Practice Address - Country:US
Practice Address - Phone:916-204-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA369509OtherPROVIDER NUMBER WITH MHN