Provider Demographics
NPI:1851447841
Name:MCNABB, DONNA JO (MA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:MCNABB
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PRETTY RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-9608
Mailing Address - Country:US
Mailing Address - Phone:802-657-3590
Mailing Address - Fax:
Practice Address - Street 1:245 SOUTH PARK DR
Practice Address - Street 2:COUNSELING CONNECTION - SUITE 2
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-264-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009982Medicaid