Provider Demographics
NPI:1760757793
Name:BAYNES, DONNA LOUISE (LPC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LOUISE
Last Name:BAYNES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:BAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:165 N CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-5635
Mailing Address - Country:US
Mailing Address - Phone:770-361-3454
Mailing Address - Fax:
Practice Address - Street 1:110 HABERSHAM DR
Practice Address - Street 2:113
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1381
Practice Address - Country:US
Practice Address - Phone:770-361-3454
Practice Address - Fax:770-371-5002
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional