Provider Demographics
NPI:1306294202
Name:DONOHUE, FAITH
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:DONOHUE
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 1:4048 N CLARK ST
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1983
Mailing Address - Country:US
Mailing Address - Phone:312-399-3284
Mailing Address - Fax:
Practice Address - Street 1:4048 N CLARK ST
Practice Address - Street 2:UNIT G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1983
Practice Address - Country:US
Practice Address - Phone:312-399-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0184451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical