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Individual

DONNA SOUTHARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA LCPC

Contact information

Practice address
2325 177TH ST, LANSING, IL 60438-1722
(708) 895-7310
Mailing address
1701 FORSYTHIA ST SE, DEMOTTE, IN 46310-8264
(219) 472-1757

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180003601
IL

Other

Enumeration date
01/03/2014
Last updated
01/03/2014
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