Provider Demographics
NPI:1407059017
Name:DONALDSON, SUSAN V (MFT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:V
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BREEDERS CUP PL
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-5128
Mailing Address - Country:US
Mailing Address - Phone:951-372-9152
Mailing Address - Fax:
Practice Address - Street 1:448 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1205
Practice Address - Country:US
Practice Address - Phone:909-599-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist