Provider Demographics
NPI:1912799313
Name:MCDONALD, NANCY LOUISE
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LOUISE
Last Name:MCDONALD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1586 WINCHESTER AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-5014
Mailing Address - Country:US
Mailing Address - Phone:304-267-0818
Mailing Address - Fax:
Practice Address - Street 1:1586 WINCHESTER AVE UNIT A
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-5014
Practice Address - Country:US
Practice Address - Phone:304-267-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009471901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical