Provider Demographics
NPI:1063878858
Name:MCDOUGALD, TANGIE R (LPC)
Entity type:Individual
Prefix:
First Name:TANGIE
Middle Name:R
Last Name:MCDOUGALD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1001
Mailing Address - Country:US
Mailing Address - Phone:860-236-4511
Mailing Address - Fax:
Practice Address - Street 1:205 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2355
Practice Address - Country:US
Practice Address - Phone:860-282-8882
Practice Address - Fax:860-282-8890
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor