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General NPI Number Information
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NPI Number | 1184992257
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Entity Type | Individual
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Provider Name | DONNA MARIA RUNKLES M.S. L-CADC
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Gender | Female
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 401 BOW ST.
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City | ELKTON
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State | MD
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Zip | 21921
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Country | US
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Telephone | 410-996-5106
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Fax | 410-996-5707
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Provider Business Mailing Address
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Address Line | 401 BOW ST
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City | ELKTON
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State | MD
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Zip | 21921-5501
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Country | US
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Telephone | 410-996-5106
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Fax | 410-996-5707
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCA141
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License Number State | MD
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