Provider Demographics
NPI:1831729425
Name:MCDONALD, IRVIN ALONZO
Entity type:Individual
Prefix:
First Name:IRVIN
Middle Name:ALONZO
Last Name:MCDONALD
Suffix:
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:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-0219
Mailing Address - Country:US
Mailing Address - Phone:937-305-5119
Mailing Address - Fax:
Practice Address - Street 1:332 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4918
Practice Address - Country:US
Practice Address - Phone:937-529-4996
Practice Address - Fax:937-529-0055
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health