Provider Demographics
NPI:1619393287
Name:DOUGALL, JENNIFER LARA (PHD, PCC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LARA
Last Name:DOUGALL
Suffix:
Gender:F
Credentials:PHD, PCC
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 4034
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-0034
Mailing Address - Country:US
Mailing Address - Phone:330-805-4587
Mailing Address - Fax:330-805-4587
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-805-4587
Practice Address - Fax:330-805-4587
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0007143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional