Provider Demographics
NPI:1255203816
Name:DONAHOE, KASSIDY
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:
Last Name:DONAHOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MONTROSE AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2410
Mailing Address - Country:US
Mailing Address - Phone:540-629-5052
Mailing Address - Fax:
Practice Address - Street 1:860 MOUNT VERNON LN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-2700
Practice Address - Country:US
Practice Address - Phone:540-389-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701015414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional