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General NPI Number Information
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NPI Number | 1700544400
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Entity Type | Individual
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Provider Name | ALICIA K MCDONOUGH MHC-LP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 590 FLATBUSH AVE APT 14S
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City | BROOKLYN
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State | NY
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Zip | 11225-4994
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Country | US
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Telephone | 917-722-2392
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Fax |
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Provider Business Mailing Address
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Address Line | 587 BROADWAY APT D2
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City | MENANDS
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State | NY
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Zip | 12204-2828
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Country | US
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Telephone | 518-423-0934
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P112140
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License Number State | NY
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