Provider Demographics
NPI:1497956718
Name:SEAL, DONNA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:J
Last Name:SEAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 PECAN LN
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-1216
Mailing Address - Country:US
Mailing Address - Phone:870-598-2017
Mailing Address - Fax:870-598-3373
Practice Address - Street 1:224 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857
Practice Address - Country:US
Practice Address - Phone:870-598-3402
Practice Address - Fax:870-598-3373
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1280-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARS38155Medicare UPIN
AR5T533Medicare ID - Type Unspecified