Provider Demographics
NPI:1811408545
Name:BRENDA B. DONALD, LLC
Entity Type:Organization
Organization Name:BRENDA B. DONALD, LLC
Other - Org Name:BRENDA B. DONALD, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-519-5811
Mailing Address - Street 1:133 EXECUTIVE DR STE D
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8440
Mailing Address - Country:US
Mailing Address - Phone:601-898-7778
Mailing Address - Fax:601-607-5019
Practice Address - Street 1:133 EXECUTIVE DR STE D
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8440
Practice Address - Country:US
Practice Address - Phone:601-898-7778
Practice Address - Fax:601-607-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC09021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty