Provider Demographics
NPI:1295192904
Name:SINEGAL, DONOVAN JEMAL I
Entity Type:Individual
Prefix:MR
First Name:DONOVAN
Middle Name:JEMAL
Last Name:SINEGAL
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 KIRKMAN ST
Mailing Address - Street 2:SUIT A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5391
Mailing Address - Country:US
Mailing Address - Phone:337-419-3586
Mailing Address - Fax:855-239-9737
Practice Address - Street 1:1202 KIRKMAN ST
Practice Address - Street 2:SUIT A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5391
Practice Address - Country:US
Practice Address - Phone:337-419-3586
Practice Address - Fax:855-239-9737
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1889253Medicaid