Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 6401003770 | MI |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6401003770 | MI |
N | 101YM0800X | Mental Health Counselor | 6401003770 | MI |
N | 101YP2500X | Professional Counselor | 6401003770 | MI |
N | 102L00000X | Psychologist | 6301009941 | MI |
N | 103T00000X | Psychologist | 6301009941 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301009941 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301009941 | MI |
N | 103G00000X | Clinical Psychologist | 6301009941 | MI |
N | 103TC0700X | Clinical Psychologist | 6301009941 | MI |
N | 103TC1900X | Counseling Psychologist | 6301009941 | MI |
N | 103TF0000X | Family Psychologist | 6301009941 | MI |
N | 103TF0200X | Forensic Psychologist | 6301009941 | MI |
N | 103TP2701X | Group Psychotherapist | 6301009941 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301009941 | MI |
NPI | 1104035385 |
---|---|
Provider Name | Mr. Charles D Donaldson |
First Address | Holland, MI 49423-3794 |
Second Address | Holland, MI 49423-3794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0895544 | BLUE CROSS BLUE SHIELD (01) | MI |