Provider Demographics
NPI:1205058559
Name:POE, DONNA MARIE (AHT RTEI)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:POE
Suffix:
Gender:F
Credentials:AHT RTEI
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AHT
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:CA
Mailing Address - Zip Code:96014
Mailing Address - Country:US
Mailing Address - Phone:530-467-5135
Mailing Address - Fax:
Practice Address - Street 1:1515 S OREGON ST
Practice Address - Street 2:SUITE A
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097
Practice Address - Country:US
Practice Address - Phone:530-842-3455
Practice Address - Fax:530-842-7917
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker