Provider Demographics
NPI:1144715376
Name:CHAPMAN, DONNA S (LCDC III)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:S
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDINA RESIDENTIAL SOBER LIVING
Mailing Address - Street 2:3141 MEDINA AVENUE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1217
Mailing Address - Country:US
Mailing Address - Phone:740-815-2595
Mailing Address - Fax:
Practice Address - Street 1:3141 MEDINA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4222
Practice Address - Country:US
Practice Address - Phone:740-815-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)