Provider Demographics
NPI:1245495456
Name:DONATO, NICOLE SAMANTHA (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SAMANTHA
Last Name:DONATO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-9754
Mailing Address - Country:US
Mailing Address - Phone:856-825-6810
Mailing Address - Fax:
Practice Address - Street 1:2038 CARMEL RD
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-9754
Practice Address - Country:US
Practice Address - Phone:856-825-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00348500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional