Provider Demographics
NPI:1306091905
Name:MCDOUGALD, VICTORIA (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:MCDOUGALD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-0313
Mailing Address - Country:US
Mailing Address - Phone:252-228-9595
Mailing Address - Fax:
Practice Address - Street 1:3707 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1485
Practice Address - Country:US
Practice Address - Phone:252-228-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162221Medicaid