Provider Demographics
NPI:1184992257
Name:RUNKLES, DONNA MARIA (MS L-CADC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIA
Last Name:RUNKLES
Suffix:
Gender:F
Credentials:MS L-CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BOW ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5501
Mailing Address - Country:US
Mailing Address - Phone:410-996-5106
Mailing Address - Fax:410-996-5707
Practice Address - Street 1:401 BOW ST.
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-996-5106
Practice Address - Fax:410-996-5707
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA141101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)