Provider Demographics
NPI:1720885130
Name:DONAHUE, MARANDA LEE (LPC)
Entity type:Individual
Prefix:MS
First Name:MARANDA
Middle Name:LEE
Last Name:DONAHUE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 30TH AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5000
Mailing Address - Country:US
Mailing Address - Phone:701-306-9340
Mailing Address - Fax:218-284-1080
Practice Address - Street 1:819 30TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5000
Practice Address - Country:US
Practice Address - Phone:218-979-3560
Practice Address - Fax:218-284-1080
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health