Provider Demographics
NPI:1356322481
Name:STROM, DONNA ELAINE (ED S LPC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ELAINE
Last Name:STROM
Suffix:
Gender:F
Credentials:ED S LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W MARTINTOWN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3175
Mailing Address - Country:US
Mailing Address - Phone:803-640-0679
Mailing Address - Fax:866-277-2650
Practice Address - Street 1:419 W MARTINTOWN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3175
Practice Address - Country:US
Practice Address - Phone:803-640-0679
Practice Address - Fax:866-277-2650
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional