Provider Demographics
NPI:1003537119
Name:ANDERSON, DONNA TERESA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:TERESA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3965
Mailing Address - Country:US
Mailing Address - Phone:202-491-5130
Mailing Address - Fax:
Practice Address - Street 1:2285 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3965
Practice Address - Country:US
Practice Address - Phone:202-491-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD290601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical