Provider Demographics
NPI:1013054345
Name:CRONK, DONALD ALDEN III (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ALDEN
Last Name:CRONK
Suffix:III
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2827
Mailing Address - Country:US
Mailing Address - Phone:574-277-7734
Mailing Address - Fax:574-277-7734
Practice Address - Street 1:616 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2827
Practice Address - Country:US
Practice Address - Phone:574-277-7734
Practice Address - Fax:574-277-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000750A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health