Provider Demographics
NPI:1073156683
Name:FARRELL, DONNA LYNN (LPCA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:FARRELL
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 1:40 FOLLY FIELD ROAD
Mailing Address - Street 2:C 251
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928
Mailing Address - Country:US
Mailing Address - Phone:803-640-5695
Mailing Address - Fax:
Practice Address - Street 1:40 FOLLY FIELD ROAD
Practice Address - Street 2:C 251
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928
Practice Address - Country:US
Practice Address - Phone:803-640-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional