Healthcare Provider Details

I. General information

NPI: 1710465505
Provider Name (Legal Business Name): DONNA L. HUNSTOCK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N NEW HAMPSHIRE ST STE 8
COVINGTON LA
70433-2843
US

IV. Provider business mailing address

101 MAGNOLIA GARDENS DR
COVINGTON LA
70435-9524
US

V. Phone/Fax

Practice location:
  • Phone: 985-630-2400
  • Fax: 985-790-7120
Mailing address:
  • Phone: 985-630-2400
  • Fax: 985-790-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2772
License Number StateLA

VIII. Authorized Official

Name: DONNA LYNNE HUNSTOCK
Title or Position: PRESIDENT
Credential:
Phone: 985-630-2400