Provider Demographics
NPI:1336269695
Name:DONALDSON, MICHELLE ANNE (MS)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:ANNE
Other - Last Name:WOFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1431
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:951-522-6766
Mailing Address - Fax:909-399-0829
Practice Address - Street 1:167 N THIRD AVE
Practice Address - Street 2:STE L
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:951-522-6766
Practice Address - Fax:909-399-0829
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT31842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist