Basic Information
| Provider Information | |||||||||
| NPI: | 1972722270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDOUGALL | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 914 N CANAL ST | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882205110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758854836 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 914 N CANAL ST | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882205110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758854836 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | T-0098431 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.