Provider Demographics
NPI:1467890418
Name:KROENER, DONNA KAY
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KAY
Last Name:KROENER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:KAY
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4104 MARQUESAS AVE
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8531
Mailing Address - Country:US
Mailing Address - Phone:425-760-7698
Mailing Address - Fax:
Practice Address - Street 1:2233 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-6941
Practice Address - Country:US
Practice Address - Phone:803-835-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4601103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool