Provider Demographics
NPI:1205982378
Name:GIVENS, DONNA (RN,MA,LCPC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:GIVENS
Suffix:
Gender:F
Credentials:RN,MA,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 BURGETT LN
Mailing Address - Street 2:
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-7748
Mailing Address - Country:US
Mailing Address - Phone:618-973-5072
Mailing Address - Fax:
Practice Address - Street 1:501 S 4TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1715
Practice Address - Country:US
Practice Address - Phone:618-973-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005628101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180005628OtherCREDENTIALING WITH SEVERAL INSURANCES FOR PRIVATE PRACTICE