MEDICARE: MR. MARK DAVID DONOVAN LCPC, LCADC

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	LCA414	MD
2	101YM0800X	Mental Health Counselor	LC0912	MD
3	101YP2500X	Professional Counselor	LC0912	MD

General Provider Information

NPI Number	:	1912909730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK DAVID DONOVAN LCPC, LCADC

Provider Business Mailing Address
First Line	:	10630 LITTLE PATUXENT PKWY
Second Line	:	SUITE 209
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3264
Country	:	US
Telephone Number	:	410-740-8066
Fax Number	:	410-740-8068

Provider Business Practice Location Address
First Line	:	10630 LITTLE PATUXENT PKWY STE 209
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-6278
Country	:	US
Telephone Number	:	410-740-8066
Fax Number	:	410-740-8068

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/09/2021

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