Provider Demographics
NPI:1386308187
Name:DONOVAN, LOREAL (LPC)
Entity type:Individual
Prefix:
First Name:LOREAL
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:SCHOOLEYS MOUNTAIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07870-0071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309D SCHOOLEYS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SCHOOLEYS MOUNTAIN
Practice Address - State:NJ
Practice Address - Zip Code:07870
Practice Address - Country:US
Practice Address - Phone:908-328-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00798100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional