MEDICARE: JOHNNA DONNELLY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	C.1901774-TRNE	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	C.2002798	OH
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1457904211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNA DONNELLY LPC

Provider Business Mailing Address
First Line	:	1213 HIGHLAND AVE
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-2646
Country	:	US
Telephone Number	:	724-234-0379
Fax Number	:

Provider Business Practice Location Address
First Line	:	11676 PERRY HWY STE 2309
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7200
Country	:	US
Telephone Number	:	814-201-1416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	08/11/2023

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Directions to “ JOHNNA DONNELLY LPC” Practice Location

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