Provider Demographics
NPI:1154649713
Name:BANN, DONNA LYNN (LCPC-C, R-DMT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNN
Last Name:BANN
Suffix:
Gender:F
Credentials:LCPC-C, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1070
Mailing Address - Country:US
Mailing Address - Phone:207-871-1200
Mailing Address - Fax:
Practice Address - Street 1:9 HOVEY LN
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-7840
Practice Address - Country:US
Practice Address - Phone:207-208-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3546101Y00000X
MER-DMT-1397225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor