Provider Demographics
NPI:1205995859
Name:STOUT, DONNA MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:STOUT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 KNOLLWOOD RD APT C
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1256
Mailing Address - Country:US
Mailing Address - Phone:410-321-4840
Mailing Address - Fax:
Practice Address - Street 1:109 W BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3221
Practice Address - Country:US
Practice Address - Phone:410-297-2271
Practice Address - Fax:410-297-2273
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health