Provider Demographics
NPI:1083166417
Name:STILL, DONNA (LAPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:STILL
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 COLUMBIA RD
Mailing Address - Street 2:STE 203
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4556
Mailing Address - Country:US
Mailing Address - Phone:706-305-3137
Mailing Address - Fax:
Practice Address - Street 1:4434 COLUMBIA RD
Practice Address - Street 2:STE 203
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4556
Practice Address - Country:US
Practice Address - Phone:706-305-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health