Provider Demographics
NPI:1902949910
Name:BROWN, DONNA RETTA (AMFT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:RETTA
Last Name:BROWN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:RETTA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:1965 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95961
Mailing Address - Country:US
Mailing Address - Phone:530-822-7200
Mailing Address - Fax:530-822-3296
Practice Address - Street 1:215 5TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5737
Practice Address - Country:US
Practice Address - Phone:530-749-7543
Practice Address - Fax:530-822-3296
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI02920315101YA0400X
CAAPCC5969101YM0800X
CA198585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA8416303OtherCADC CERTIFACATION