Mark, Donna Revae

Mark, Donna Revae is an individual health care provider with primary practice located at 921 S Beacon St , San Pedro CA 90731-3740. She recently has only one registered license in Behavioral Health & Social Service Providers / Marriage & Family Therapist, which is considered as her primary health care specialty. Mark, Donna Revae can be contacted via phone (310) 984-3055.

Contact Information

Primary practice address
921 S Beacon St San Pedro CA 90731-3740
Phone: (310) 984-3055
Fax: (310) 984-3066
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X

Profile Details

NPI number 1871785782
LBN Legal business name Mark, Donna Revae
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 14th, 2007
Last updated Oct 1st, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871785782 NPPES
California Other 55577 BOARD OF BEHAVIORAL SERVICES

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