Provider Demographics
NPI:1417120130
Name:THURSTON, DONNA JOANN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JOANN
Last Name:THURSTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 E. WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1578
Mailing Address - Country:US
Mailing Address - Phone:217-483-1224
Mailing Address - Fax:217-483-7135
Practice Address - Street 1:1835 E. WALNUT STREET
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1578
Practice Address - Country:US
Practice Address - Phone:217-483-1224
Practice Address - Fax:217-483-7135
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional