Basic Information
| Provider Information | |||||||||
| NPI: | 1750644845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRINT | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | AFMT, CAODC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 SIERRA COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | GRASS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959455768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302739541 | ||||||||
| FaxNumber: | 5302737740 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 SIERRA COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | GRASS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959455768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302739541 | ||||||||
| FaxNumber: | 5302737740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 6372 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 101090 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.