Provider Demographics
NPI:1518013499
Name:BLACKBURN, DONNA MILEY (LPC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MILEY
Last Name:BLACKBURN
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 1:10560 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4109
Mailing Address - Country:US
Mailing Address - Phone:225-924-1676
Mailing Address - Fax:225-296-3946
Practice Address - Street 1:10560 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4109
Practice Address - Country:US
Practice Address - Phone:225-924-1676
Practice Address - Fax:225-296-3946
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA72-1172721OtherFEDERAL TAX ID