Provider Demographics
NPI:1437408309
Name:DONALD, JAMES WILLIAM JR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:DONALD
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5101 WASHINGTON ST
Mailing Address - Street 2:SUITE 11 ROOM 1115
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5916
Mailing Address - Country:US
Mailing Address - Phone:847-313-9659
Mailing Address - Fax:847-557-1418
Practice Address - Street 1:5101 WASHINGTON ST
Practice Address - Street 2:SUITE 11 ROOM 1115
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5916
Practice Address - Country:US
Practice Address - Phone:847-313-9659
Practice Address - Fax:847-557-1418
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000792101YP2500X
CO1815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12482712OtherCAQH