Individual
MR. GARY D MCDOUGAL II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC, PRPS
Contact information
Practice address
614 N MARTIN ST, WARREN, AR 71671-1904
(870) 489-7903
Mailing address
GARY MCDOUGAL, 5029 ALEXANDER RD., PINE BLUFF, AR 71603
(870) 489-7903
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1690
AR
175T00000X
Peer Specialist
034
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232607795
—
AR
Enumeration date
03/08/2021
Last updated
03/08/2021
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