Provider Demographics
NPI:1326414731
Name:DONNELL, DONTAE ANTUAN SR (LPCA, LCASA)
Entity Type:Individual
Prefix:MR
First Name:DONTAE
Middle Name:ANTUAN
Last Name:DONNELL
Suffix:SR
Gender:M
Credentials:LPCA, LCASA
Other - Prefix:
Other - First Name:DONTAE
Other - Middle Name:ANTUAN
Other - Last Name:DONNELL
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LPCA, LCASA
Mailing Address - Street 1:4425 GRAY WOLF WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8260
Mailing Address - Country:US
Mailing Address - Phone:336-405-7343
Mailing Address - Fax:
Practice Address - Street 1:1451 S ELM EUGENE ST # 3112
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2200
Practice Address - Country:US
Practice Address - Phone:336-844-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21953101YA0400X
NC11737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)