Provider Demographics
NPI:1013397561
Name:DONAHOE, CHARLENE J (MS, LPC)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:J
Last Name:DONAHOE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4869 LINDEN RD APT 221
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-3429
Mailing Address - Country:US
Mailing Address - Phone:815-980-0621
Mailing Address - Fax:
Practice Address - Street 1:4869 LINDEN RD APT 221
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-3429
Practice Address - Country:US
Practice Address - Phone:815-980-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$OtherINDEPENDENT CONTRACTOR PRELICENCED PROFESSIONAL BEHAVIORAL/MENTAL HEALTH