Provider Demographics
NPI:1154646412
Name:FOFANOFF, DEANNA M (LCPC)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:M
Last Name:FOFANOFF
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 NORTHWEST BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2488
Mailing Address - Country:US
Mailing Address - Phone:208-651-2952
Mailing Address - Fax:
Practice Address - Street 1:1620 NORTHWEST BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2488
Practice Address - Country:US
Practice Address - Phone:208-651-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60142565101YP2500X
IDLCPC-9195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional