Basic Information
| Provider Information | |||||||||
| NPI: | 1922367887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACKERMAN | ||||||||
| FirstName: | DONNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 MONTEBELLO OAKS DRIVE | ||||||||
| Address2: | |||||||||
| City: | PASO ROBLES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054319224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2178 JOHNSON AVENUE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2012 | ||||||||
| LastUpdateDate: | 05/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | TRAINEE | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.