Provider Demographics
NPI:1053673756
Name:SHOCK, DONNA L (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:SHOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78-123 HOLUAKAI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2596
Mailing Address - Country:US
Mailing Address - Phone:808-365-2536
Mailing Address - Fax:
Practice Address - Street 1:78-123 HOLUAKAI ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2596
Practice Address - Country:US
Practice Address - Phone:808-365-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12101041C0700X
HI39531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical