Provider Demographics
NPI:1679128862
Name:VINEGAR, DONNA (LCPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:VINEGAR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S SAINT LAWRENCE AVE UNIT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1562
Mailing Address - Country:US
Mailing Address - Phone:773-919-7598
Mailing Address - Fax:
Practice Address - Street 1:2151 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5723
Practice Address - Country:US
Practice Address - Phone:872-233-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional