Healthcare Provider Details

I. General information

NPI: 1306770466
Provider Name (Legal Business Name): DWIGHT ALLEN MCGILL SR. PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 19084
INDIANAPOLIS IN
46219-0084
US

IV. Provider business mailing address

PO BOX 19084
INDIANAPOLIS IN
46219-0084
US

V. Phone/Fax

Practice location:
  • Phone: 346-450-4782
  • Fax:
Mailing address:
  • Phone: 346-450-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: