Provider Demographics
NPI:1245385459
Name:DONALDSON, SANDRA (MDIV)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6126 GEORGETOWN RD APT A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1244
Mailing Address - Country:US
Mailing Address - Phone:317-297-2750
Mailing Address - Fax:
Practice Address - Street 1:1050 W 42ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-3301
Practice Address - Country:US
Practice Address - Phone:317-924-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health