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General NPI Number Information
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NPI Number | 1891494027
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Entity Type | Individual
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Provider Name | MARYCLARE DONALDSON
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 71 CAVALIER BLVD STE 319
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City | FLORENCE
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State | KY
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Zip | 41042-5172
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Country | US
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Telephone | 859-363-6026
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 MYRTLE AVE
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City | COVINGTON
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State | KY
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Zip | 41015-1570
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Country | US
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Telephone | 859-445-2535
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1200418
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 259065
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License Number State | KY
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