Provider Demographics
NPI:1902013964
Name:HORINE, DONNA M (LSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:HORINE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-1532
Mailing Address - Country:US
Mailing Address - Phone:859-261-3525
Mailing Address - Fax:859-261-0883
Practice Address - Street 1:524 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1532
Practice Address - Country:US
Practice Address - Phone:859-261-3525
Practice Address - Fax:859-261-0883
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1809104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker