Provider Demographics
NPI:1245904572
Name:ANDERSON, DONYA LACHELLE (NCC)
Entity type:Individual
Prefix:
First Name:DONYA
Middle Name:LACHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 N ROCK RD STE 405
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1354
Mailing Address - Country:US
Mailing Address - Phone:316-779-8185
Mailing Address - Fax:
Practice Address - Street 1:3450 N ROCK RD STE 405
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1354
Practice Address - Country:US
Practice Address - Phone:316-779-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1496197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health