Provider Demographics
NPI:1689938672
Name:CASSELLA-JOHNSON, DONNA MARIE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:CASSELLA-JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-1229
Mailing Address - Country:US
Mailing Address - Phone:815-467-5520
Mailing Address - Fax:815-353-0334
Practice Address - Street 1:634 OAKWOOD ST
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-1229
Practice Address - Country:US
Practice Address - Phone:815-467-5520
Practice Address - Fax:815-353-0334
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008263101YM0800X
IL178006231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health