Healthcare Provider Details

I. General information

NPI: 1508973553
Provider Name (Legal Business Name): DINAH MCGUIRE DOUGLAS LICENSED PROFESSIONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 4TH ST NW
CHARLOTTESVILLE VA
22903-4562
US

IV. Provider business mailing address

401 4TH ST NW
CHARLOTTESVILLE VA
22903-4562
US

V. Phone/Fax

Practice location:
  • Phone: 434-972-1821
  • Fax: 434-970-1374
Mailing address:
  • Phone: 434-972-1821
  • Fax: 434-970-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002342
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000690
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: