Donita Michelle Lake
Counselor, Mental Health in Mokena, IL. Individual provider (NPI-1).
NPI number1710695531
StatusActive
Last updated in NPPESNov 10, 2022
Details
- NPI
- 1710695531
- Entity type
- Individual (NPI-1)
- Name
- Donita Michelle Lake
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Nov 10, 2022
- Certification date
- Nov 10, 2022
- Last updated
- Nov 10, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | – | IL | Yes |
Practice location
11225 Front StMokena, IL 60448-1303
Phone 708-537-7332
Mailing address
236 S Palmer DrBolingbrook, IL 60490-6571
Phone 708-580-2030
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