Provider Demographics
NPI:1942251947
Name:FAILE, DONNA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:FAILE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37084
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0518
Mailing Address - Country:US
Mailing Address - Phone:803-322-1383
Mailing Address - Fax:
Practice Address - Street 1:2025 EBENEZER RD
Practice Address - Street 2:K-5
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1062
Practice Address - Country:US
Practice Address - Phone:803-322-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-14
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3719101YP2500X
NC3522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102329Medicaid