Provider Demographics
NPI:1851890248
Name:GONDER-MCDONALD, PORSHA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PORSHA
Middle Name:
Last Name:GONDER-MCDONALD
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 1:309 S MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-4470
Mailing Address - Country:US
Mailing Address - Phone:870-395-0385
Mailing Address - Fax:
Practice Address - Street 1:620 S LAUREL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4859
Practice Address - Country:US
Practice Address - Phone:870-534-4900
Practice Address - Fax:870-534-4906
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2001008101Y00000X
ARP2201003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180635526Medicaid