Provider Demographics
NPI:1609944768
Name:GATES, DONNA M (MA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:GATES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N RIVERSIDE DR
Mailing Address - Street 2:#111
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5918
Mailing Address - Country:US
Mailing Address - Phone:847-625-0606
Mailing Address - Fax:
Practice Address - Street 1:501 N RIVERSIDE DR
Practice Address - Street 2:#111
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5918
Practice Address - Country:US
Practice Address - Phone:847-625-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health