=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437695020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD STEVEN MCDONALD JR. L.C.S.W.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2017
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6778 EXECUTIVE OAK LN
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-1970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-805-2514
-----------------------------------------------------
Fax | 423-531-2487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 247
-----------------------------------------------------
City | HIXSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37343-0247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-805-2514
-----------------------------------------------------
Fax | 423-531-2487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6443
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------