Provider Demographics
NPI:1235353327
Name:BONVISSUTO, DONNA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:BONVISSUTO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:GEBURA
Other - Last Name:BONVISSUTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:246 NORTHLAND DR
Mailing Address - Street 2:CATHOLIC CHARITIES SERVICES
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1533
Mailing Address - Country:US
Mailing Address - Phone:330-723-9615
Mailing Address - Fax:330-764-8795
Practice Address - Street 1:246 NORTHLAND DR
Practice Address - Street 2:CATHOLIC CHARITIES SERVICES
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1533
Practice Address - Country:US
Practice Address - Phone:330-723-9615
Practice Address - Fax:330-764-8795
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-0004355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health