Provider Demographics
NPI:1780019315
Name:DONOVAN, PENELOPE
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 WASHINGTON BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5718
Mailing Address - Country:US
Mailing Address - Phone:571-406-7079
Mailing Address - Fax:
Practice Address - Street 1:2120 WASHINGTON BLVD FL 4
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5718
Practice Address - Country:US
Practice Address - Phone:571-406-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health