Provider Demographics
NPI:1154901270
Name:GATEWOOD, DONNA CAROL
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:CAROL
Last Name:GATEWOOD
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 1:218 PINEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIDEAWAY
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5026
Mailing Address - Country:US
Mailing Address - Phone:903-245-1452
Mailing Address - Fax:
Practice Address - Street 1:218 PINEWOOD LN
Practice Address - Street 2:
Practice Address - City:HIDEAWAY
Practice Address - State:TX
Practice Address - Zip Code:75771-5026
Practice Address - Country:US
Practice Address - Phone:903-245-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15046101YA0400X
TX101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)