Doctor Name: | THERESA MCDONALD |
NPI Number: | 1053731547 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 4094 Lafayette St Marianna, FL - 324465648 |
Business Phone Number: | 8505224485 |
Business Fax Number: | 8505224484 |
Mailing Address: | 525 E 15th St, PANAMA CITY |
State: | FL |
Postal Code: | 324055412 |
Phone Number: | 8505224485 |
Fax Number: | 8505224484 |
NPI Enumeration Date: | 04/23/2014 |
NPI Last Update Date: | 04/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |