Provider Demographics
NPI:1376858142
Name:KELLY, DONNA N (LCPC-C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:N
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:23 MECHANIC STREET
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-0213
Mailing Address - Country:US
Mailing Address - Phone:207-631-0081
Mailing Address - Fax:
Practice Address - Street 1:23 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-4088
Practice Address - Country:US
Practice Address - Phone:207-631-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3681101YP2500X
MECC4132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional