Healthcare Provider Details

I. General information

NPI: 1306111331
Provider Name (Legal Business Name): JOHN DOUGLAS MCDONALD JR. M.A., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 EDDIE DOWLING HWY STE 8
NORTH SMITHFIELD RI
02896-7322
US

IV. Provider business mailing address

63 EDDIE DOWLING HWY STE 8
NORTH SMITHFIELD RI
02896-7322
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax: 781-666-2712
Mailing address:
  • Phone: 781-666-2711
  • Fax: 781-666-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01494
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66139
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: