Provider Demographics
NPI:1083439301
Name:CLEVENGER, DONNA CELESTE
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:CELESTE
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 MALUS DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7921
Mailing Address - Country:US
Mailing Address - Phone:540-562-3900
Mailing Address - Fax:540-387-6347
Practice Address - Street 1:4549 MALUS DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7921
Practice Address - Country:US
Practice Address - Phone:540-562-3900
Practice Address - Fax:540-387-6347
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-536174101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool