Provider Demographics
NPI:1124527569
Name:DONOVAN, GAIL M (LADC)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:207-554-2351
Practice Address - Street 1:128 SWEDEN ST STE 2
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2071
Practice Address - Country:US
Practice Address - Phone:207-492-1454
Practice Address - Fax:207-492-1455
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MELC8175101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor