Healthcare Provider Details

I. General information

NPI: 1124860366
Provider Name (Legal Business Name): BRIANNA L MCDOUGALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DOWD CIR STE A
PINEHURST NC
28374-7932
US

IV. Provider business mailing address

2508 BETHPAGE LN APT 205
FAYETTEVILLE NC
28311-0049
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-2609
  • Fax:
Mailing address:
  • Phone: 984-365-9598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: