Provider Demographics
NPI:1164990628
Name:FARLEY, DONNA (LCPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FARLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 WATER LILY CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2996
Mailing Address - Country:US
Mailing Address - Phone:301-807-6415
Mailing Address - Fax:
Practice Address - Street 1:3208 WATER LILY CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2996
Practice Address - Country:US
Practice Address - Phone:301-807-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2022-11-21
Deactivation Date:2021-05-05
Deactivation Code:
Reactivation Date:2022-11-21
Provider Licenses
StateLicense IDTaxonomies
MDLC9069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113786079OtherIRS TIN