Healthcare Provider Details

I. General information

NPI: 1386172849
Provider Name (Legal Business Name): TAMARA LACHAE MCDOUGALD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9140 MORGAN ST
LAUREL HILL NC
28351
US

IV. Provider business mailing address

185 MITTIE HADDOCK DR
CAMERON NC
28326-9379
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 919-498-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: