Provider Demographics
NPI:1295225092
Name:DONALD, JEAN (LMFT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:DONALD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601C BLANDING AVE # 160
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1507
Mailing Address - Country:US
Mailing Address - Phone:510-545-3166
Mailing Address - Fax:
Practice Address - Street 1:1701 SHORELINE DR APT 107
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6001
Practice Address - Country:US
Practice Address - Phone:510-545-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96567101YM0800X
CA125774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health