Provider Demographics
NPI:1477751170
Name:KINGSBURY, DONNA (LPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 CROSS COUNTY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8470
Mailing Address - Country:US
Mailing Address - Phone:843-817-2574
Mailing Address - Fax:866-263-4021
Practice Address - Street 1:7455 CROSS COUNTY RD STE 6
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418
Practice Address - Country:US
Practice Address - Phone:843-817-2574
Practice Address - Fax:866-263-4021
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2895, 3865101YA0400X
SC2895 AND 3865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLPC SUPERVISOR 3865OtherLIC. PROF. COUN. SUPERVIS
SCAD16DOMedicaid
SCLPC-2895OtherLICENSED PROF. COUNSELOR