Provider Demographics
NPI:1093060022
Name:MELDRUM, DONNA L (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:L
Last Name:MELDRUM
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CASS AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MT. CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043
Mailing Address - Country:US
Mailing Address - Phone:586-260-7835
Mailing Address - Fax:586-468-5270
Practice Address - Street 1:117 CASS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2252
Practice Address - Country:US
Practice Address - Phone:586-260-7835
Practice Address - Fax:586-468-5270
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011811101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist