Provider Demographics
NPI:1598339475
Name:MUSSELWHITE, DONNA LYNN
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:MUSSELWHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 VINELAND CIR UNIT B
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4208
Mailing Address - Country:US
Mailing Address - Phone:904-537-9864
Mailing Address - Fax:
Practice Address - Street 1:1565 VINELAND CIR UNIT B
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4208
Practice Address - Country:US
Practice Address - Phone:904-537-9864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL799541101YS0200X
FLMH5350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty