Provider Demographics
NPI:1497274534
Name:BOHANNON, DONALD LEWIS (LPC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEWIS
Last Name:BOHANNON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 BASALT DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7229
Mailing Address - Country:US
Mailing Address - Phone:928-502-1926
Mailing Address - Fax:
Practice Address - Street 1:10712 BALLANTRAYE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4702
Practice Address - Country:US
Practice Address - Phone:928-628-8517
Practice Address - Fax:928-502-1926
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-09
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty