Basic Information
| Provider Information | |||||||||
| NPI: | 1972020295 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY MATTERS, LLC | ||||||||
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| OtherOrganizationName: | TANGIE R. MCDOUGALD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 HARBISON AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061063013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609444444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 BURNSIDE AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061082355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602828882 | ||||||||
| FaxNumber: | 8602828890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 08/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | MCDOUGALD | ||||||||
| AuthorizedOfficialFirstName: | TANGIE | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8602828882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 003265 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.