Provider Demographics
NPI:1710595038
Name:DONAHUE, MATTHEW ADAM (LGPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ADAM
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 W 7TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-8532
Mailing Address - Country:US
Mailing Address - Phone:240-575-9688
Mailing Address - Fax:301-732-6916
Practice Address - Street 1:10 DISTILLERY RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5344
Practice Address - Country:US
Practice Address - Phone:410-871-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10533101YM0800X
MDLC12573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health