Provider Demographics
NPI:1851635742
Name:GATES, DONNA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:GATES
Suffix:
Gender:F
Credentials:PHD
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 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04850-0300
Mailing Address - Country:US
Mailing Address - Phone:207-356-8542
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1703
Practice Address - Country:US
Practice Address - Phone:207-356-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPSY979103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical