Healthcare Provider Details

I. General information

NPI: 1316892011
Provider Name (Legal Business Name): CATHERINE MARIE MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 COMMERCE ST
LOCKBOURNE OH
43137-9305
US

IV. Provider business mailing address

51 COMMERCE ST
LOCKBOURNE OH
43137-9305
US

V. Phone/Fax

Practice location:
  • Phone: 614-261-2335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195597
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: