Provider Demographics
NPI:1215604210
Name:DONAGHUE, CHRIS M (PHD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:M
Last Name:DONAGHUE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 LARCHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:444 LARCHMONT AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:CA
Practice Address - Zip Code:90004
Practice Address - Country:US
Practice Address - Phone:310-790-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health