Provider Demographics
NPI:1447349832
Name:DONOVAN, SARAH BETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BETH
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 1:1160 KEPLER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8321
Mailing Address - Country:US
Mailing Address - Phone:920-288-5500
Mailing Address - Fax:920-288-5510
Practice Address - Street 1:1160 KEPLER DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311
Practice Address - Country:US
Practice Address - Phone:920-288-5500
Practice Address - Fax:920-288-5510
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICADC-D #13860101YA0400X
WI3564-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40997300OtherMEDICAL ASSISTANCE