Provider Demographics
NPI:1023730066
Name:SEELY, DONNA MORICONI (MA, LLP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MORICONI
Last Name:SEELY
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:MORICONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:8717 MESKILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MI
Mailing Address - Zip Code:48063-1901
Mailing Address - Country:US
Mailing Address - Phone:248-909-1379
Mailing Address - Fax:
Practice Address - Street 1:30472 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1844
Practice Address - Country:US
Practice Address - Phone:586-863-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical