Provider Demographics
NPI:1215310636
Name:BRANCH, DONNA MARIE (MA, LADC, LAMFT, AMF)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:BRANCH
Suffix:
Gender:F
Credentials:MA, LADC, LAMFT, AMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2244
Mailing Address - Country:US
Mailing Address - Phone:858-766-9981
Mailing Address - Fax:858-259-0197
Practice Address - Street 1:28126 ORANGEGROVE AVE
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8889
Practice Address - Country:US
Practice Address - Phone:760-557-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303674101YA0400X
CARA9480519101YA0400X
MN3639106H00000X
CA125656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)