Provider Demographics
NPI:1730231903
Name:FLEITAS, DONNA SUSANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:SUSANNE
Last Name:FLEITAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 280 BYP
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-6608
Mailing Address - Country:US
Mailing Address - Phone:334-297-4418
Mailing Address - Fax:334-291-0354
Practice Address - Street 1:1011 280 BYP
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-6608
Practice Address - Country:US
Practice Address - Phone:334-297-4418
Practice Address - Fax:334-291-0354
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1135101Y00000X
GAPSY001964101YA0400X
AL748103T00000X
GA1964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist