Provider Demographics
NPI:1285198341
Name:POPPENDIECK, DONNA LYNNE (LICDC-CS, OCPSII)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNNE
Last Name:POPPENDIECK
Suffix:
Gender:F
Credentials:LICDC-CS, OCPSII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4766 SHELL CT S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2048
Mailing Address - Country:US
Mailing Address - Phone:614-209-7889
Mailing Address - Fax:
Practice Address - Street 1:4766 SHELL CT S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2048
Practice Address - Country:US
Practice Address - Phone:614-209-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0939-C03405300000X
OH001355101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional