Provider Demographics
NPI:1972889368
Name:NAFFAH, DONNA KIM (LPC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:KIM
Last Name:NAFFAH
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 1:1350 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3542
Mailing Address - Country:US
Mailing Address - Phone:276-492-3772
Mailing Address - Fax:276-644-9113
Practice Address - Street 1:1350 LEE HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3542
Practice Address - Country:US
Practice Address - Phone:276-492-3772
Practice Address - Fax:276-644-9113
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972889368Medicaid