Provider Demographics
NPI:1962860320
Name:RANKINS, DONNA (CG60486608)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:RANKINS
Suffix:
Gender:F
Credentials:CG60486608
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 NE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-1116
Mailing Address - Country:US
Mailing Address - Phone:360-253-6019
Mailing Address - Fax:
Practice Address - Street 1:7415 NE 94TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-3859
Practice Address - Country:US
Practice Address - Phone:360-253-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60486608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health