Provider Demographics
NPI:1154044493
Name:DRAKE, DONNA COLLEEN (LPC, LCAD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:COLLEEN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LPC, LCAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 BRYN MAWR DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2689
Mailing Address - Country:US
Mailing Address - Phone:816-507-6002
Mailing Address - Fax:
Practice Address - Street 1:3122 BRYN MAWR DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2689
Practice Address - Country:US
Practice Address - Phone:816-507-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty