Provider Demographics
NPI:1154446219
Name:DELICH, DONNA J (LCSW LAC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:DELICH
Suffix:
Gender:F
Credentials:LCSW LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2000
Mailing Address - Country:US
Mailing Address - Phone:406-222-2812
Mailing Address - Fax:406-222-4764
Practice Address - Street 1:320 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2000
Practice Address - Country:US
Practice Address - Phone:406-223-3104
Practice Address - Fax:406-333-2888
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical