Healthcare Provider Details

I. General information

NPI: 1043762909
Provider Name (Legal Business Name): DEBRA DONAHUE-SHARSTROM LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 HILLCREST AVE
SPICER MN
56288-0016
US

IV. Provider business mailing address

PO BOX 15
NEW LONDON MN
56273-0015
US

V. Phone/Fax

Practice location:
  • Phone: 218-640-6133
  • Fax: 218-600-5008
Mailing address:
  • Phone: 218-640-6133
  • Fax: 218-600-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302415
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: