Provider Demographics
NPI:1003068131
Name:BRUNETTI, DONNA MARIE (LPCC, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:BRUNETTI
Suffix:
Gender:F
Credentials:LPCC, LMHC, LPC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, LMHC, LPC
Mailing Address - Street 1:3235 LUPINE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8442
Mailing Address - Country:US
Mailing Address - Phone:949-445-0456
Mailing Address - Fax:206-333-0954
Practice Address - Street 1:3235 LUPINE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8442
Practice Address - Country:US
Practice Address - Phone:845-406-7245
Practice Address - Fax:206-333-0954
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA010680315101YA0400X
NY006110101YM0800X
CALPCC 1669101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional