Individual
MR. JUSTIN DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
135 QUITA CIR APT B, LEBANON, TN 37087-4440
(615) 955-1729
Mailing address
135 QUITA CIR APT B, LEBANON, TN 37087-4440
(615) 955-1729
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
TN
175T00000X
Peer Specialist
Primary
000-1205
TN
Other
Enumeration date
03/08/2016
Last updated
08/06/2020
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