Provider Demographics
NPI:1609849314
Name:DENT, DONNA S (LPC; LSATP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:S
Last Name:DENT
Suffix:
Gender:F
Credentials:LPC; LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ELM AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4001
Mailing Address - Country:US
Mailing Address - Phone:540-345-9841
Mailing Address - Fax:540-527-2900
Practice Address - Street 1:2702 LIBERTY RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-4745
Practice Address - Country:US
Practice Address - Phone:540-981-1102
Practice Address - Fax:540-344-4169
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002951101Y00000X
VA0718000108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA286105OtherANTHEM
VA286105OtherHEALTHKEEPERS