Healthcare Provider Details

I. General information

NPI: 1174088710
Provider Name (Legal Business Name): LAURA DONNELLY MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 STARRET ST STE 100
LANCASTER OH
43130-3993
US

IV. Provider business mailing address

624 E MAIN ST
LANCASTER OH
43130-3903
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0042
  • Fax:
Mailing address:
  • Phone: 740-417-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2002922
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2203117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: