Provider Demographics
NPI:1053682393
Name:EWING-MASSIE, DONNA (LSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:EWING-MASSIE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COURTYARD LN
Mailing Address - Street 2:APT. 10
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-1471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 COURTYARD LN
Practice Address - Street 2:APT. 10
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-1471
Practice Address - Country:US
Practice Address - Phone:302-757-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1041C0700X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker