Provider Demographics
NPI:1770641979
Name:DONALDSON, DORRAN (LPC)
Entity Type:Individual
Prefix:
First Name:DORRAN
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80591
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0591
Mailing Address - Country:US
Mailing Address - Phone:706-357-9447
Mailing Address - Fax:706-742-5495
Practice Address - Street 1:975 GAINES SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3133
Practice Address - Country:US
Practice Address - Phone:706-357-9447
Practice Address - Fax:706-742-5495
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2961103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 2010Medicare ID - Type Unspecified