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General NPI Number Information
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NPI Number | 1811408545
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Entity Type | Organization
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Legal Business Name | BRENDA B. DONALD, LLC
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 133 EXECUTIVE DR STE D
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City | MADISON
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State | MS
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Zip | 39110-8440
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Country | US
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Telephone | 601-898-7778
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Fax | 601-607-5019
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Provider Business Mailing Address
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Address Line | 133 EXECUTIVE DR STE D
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City | MADISON
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State | MS
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Zip | 39110-8440
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Country | US
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Telephone | 601-898-7778
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Fax | 601-607-5019
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Authorized Official
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Title or Position | ASSISTANT
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Name | COURTNEY B. CHANCE
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Credential |
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Telephone | 601-519-5811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C0902
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License Number State | MS
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