Individual
AUDREY MCDOUGAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 ESTUDILLO AVE STE 100, SAN LEANDRO, CA 94577-4962
(510) 352-9200
Mailing address
400 ESTUDILLO AVE STE 100, SAN LEANDRO, CA 94577-4962
(510) 352-9200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
ASW87597
CA
1041C0700X
Clinical Social Worker
Primary
LCSW106518
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1300881
—
MA
Enumeration date
02/04/2013
Last updated
06/10/2024
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