Provider Demographics
NPI:1336229400
Name:LEVIN, DONNA (MFT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 BROADWAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4901
Mailing Address - Country:US
Mailing Address - Phone:619-504-4996
Mailing Address - Fax:619-464-1157
Practice Address - Street 1:1252 BROADWAY
Practice Address - Street 2:SUITE E
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4901
Practice Address - Country:US
Practice Address - Phone:619-504-4996
Practice Address - Fax:619-464-1157
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC6329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist