Provider Demographics
NPI:1699740548
Name:VANDERWYST, DONNA MAE (LPC)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MAE
Last Name:VANDERWYST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:VANDERWYST STRNAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:28 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2517
Mailing Address - Country:US
Mailing Address - Phone:610-247-3708
Mailing Address - Fax:
Practice Address - Street 1:28 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2517
Practice Address - Country:US
Practice Address - Phone:610-247-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7751663OtherAETNA