Provider Demographics
NPI:1881836922
Name:CARRASCO, DONNA KENNEDY (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KENNEDY
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:ANETTE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:835 TOWER DR STE 19
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4251
Mailing Address - Country:US
Mailing Address - Phone:432-210-5200
Mailing Address - Fax:
Practice Address - Street 1:835 TOWER DR STE 19
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4251
Practice Address - Country:US
Practice Address - Phone:432-210-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61890101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor