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General NPI Number Information
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NPI Number | 1407059017
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Entity Type | Individual
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Provider Name | SUSAN V DONALDSON MFT
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Gender | Female
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Dates
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Enumeration Date | 06/09/2007
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 448 E FOOTHILL BLVD SUITE 101
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City | SAN DIMAS
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State | CA
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Zip | 91773-1205
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Country | US
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Telephone | 909-599-0242
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Fax |
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Provider Business Mailing Address
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Address Line | 119 BREEDERS CUP PL
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City | NORCO
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State | CA
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Zip | 92860-5128
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Country | US
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Telephone | 951-372-9152
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 44168
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License Number State | CA
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