Provider Demographics
NPI:1245662014
Name:STEFANICK, DONNA LYNN
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNN
Last Name:STEFANICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8802 BIGGS FORD RD
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-8415
Mailing Address - Country:US
Mailing Address - Phone:908-444-1110
Mailing Address - Fax:
Practice Address - Street 1:8802 BIGGS FORD RD
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8415
Practice Address - Country:US
Practice Address - Phone:908-444-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP1600X
NJ37LC00234600101YA0400X
LCA2961101YM0800X
MDLCA2961101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100284691Medicaid