Provider Demographics
NPI:1255490579
Name:AUCOIN, DONNA LEBLANC (PHD, MP)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LEBLANC
Last Name:AUCOIN
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7449
Mailing Address - Country:US
Mailing Address - Phone:337-237-0788
Mailing Address - Fax:337-237-0785
Practice Address - Street 1:3312 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7449
Practice Address - Country:US
Practice Address - Phone:337-237-0788
Practice Address - Fax:337-237-0785
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMP.000839103T00000X
LA839103TM1800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA72-1568213OtherTAX ID NUMBER