Provider Demographics
NPI:1043200017
Name:WALSH JOHNSON, DONNA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:WALSH JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4005 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7666
Mailing Address - Country:US
Mailing Address - Phone:623-322-4898
Mailing Address - Fax:623-536-9806
Practice Address - Street 1:501 E PLAZA CIR
Practice Address - Street 2:SUITE A
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4998
Practice Address - Country:US
Practice Address - Phone:623-536-7956
Practice Address - Fax:623-536-9806
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW10588101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
102690Medicare ID - Type Unspecified