Provider Demographics
NPI:1093931867
Name:DONALDSON, BRENDA A (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 E THREE NOTCH ST
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-3406
Mailing Address - Country:US
Mailing Address - Phone:334-222-6825
Mailing Address - Fax:
Practice Address - Street 1:19815 BAY BRANCH RD
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-9234
Practice Address - Country:US
Practice Address - Phone:334-222-2523
Practice Address - Fax:334-222-4660
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL62-31336OtherUBH PLUS
AL62-30336OtherUBH BASIC