Provider Demographics
NPI:1326541525
Name:WIECZOREK, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WIECZOREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 REDLEVEL WALK
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6207
Mailing Address - Country:US
Mailing Address - Phone:770-683-9375
Mailing Address - Fax:
Practice Address - Street 1:100 GLENDALOUGH CT STE E
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2942
Practice Address - Country:US
Practice Address - Phone:770-683-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor