Provider Demographics
NPI:1790346492
Name:PATRICK, DONAE LATOYA (LPC)
Entity Type:Individual
Prefix:
First Name:DONAE
Middle Name:LATOYA
Last Name:PATRICK
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 1:2650 S FORUM DR APT 4205
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7054
Mailing Address - Country:US
Mailing Address - Phone:989-295-0477
Mailing Address - Fax:
Practice Address - Street 1:2650 S FORUM DR APT 4205
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7054
Practice Address - Country:US
Practice Address - Phone:989-295-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty