Provider Demographics
NPI:1043669856
Name:LANDES, DONNA R (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:R
Last Name:LANDES
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3503
Mailing Address - Country:US
Mailing Address - Phone:910-592-4507
Mailing Address - Fax:910-592-4494
Practice Address - Street 1:707 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3503
Practice Address - Country:US
Practice Address - Phone:910-592-4507
Practice Address - Fax:910-592-4494
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional