Provider Demographics
NPI:1104033505
Name:DONAHUE, MARY EMILY MCKAY PUGH (LPCC)
Entity Type:Individual
Prefix:
First Name:MARY EMILY
Middle Name:MCKAY PUGH
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MARY EMILY
Other - Middle Name:MCKAY
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:586 LAMONT COURT NORTH
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928
Mailing Address - Country:US
Mailing Address - Phone:707-293-7096
Mailing Address - Fax:
Practice Address - Street 1:586 LAMONT COURT NORTH
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928
Practice Address - Country:US
Practice Address - Phone:707-293-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC558101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor