Provider Demographics
NPI:1255547808
Name:LINDSTROM, DONALD FREDRICK JR (MFT)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:FREDRICK
Last Name:LINDSTROM
Suffix:JR
Gender:M
Credentials:MFT
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:FREDRICK
Other - Last Name:LINDSTROM
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:505 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3513
Mailing Address - Country:US
Mailing Address - Phone:334-382-9584
Mailing Address - Fax:
Practice Address - Street 1:210 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-2606
Practice Address - Country:US
Practice Address - Phone:334-382-8914
Practice Address - Fax:334-382-6807
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL 148106H00000X
FL0000962106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist