Provider Demographics
NPI:1952682601
Name:DONOVAN, ALBA LETICIA (PHD)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:LETICIA
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALBA
Other - Middle Name:LETICIA
Other - Last Name:TAPIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 MISSION SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-6941
Mailing Address - Country:US
Mailing Address - Phone:805-602-7229
Mailing Address - Fax:
Practice Address - Street 1:280 MISSION SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-6941
Practice Address - Country:US
Practice Address - Phone:805-602-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33772103TF0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health