Provider Demographics
NPI:1083715874
Name:SMITH, DONNA SHARON (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:SHARON
Last Name:SMITH
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 1:12610 ICELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-7600
Mailing Address - Country:US
Mailing Address - Phone:225-275-1537
Mailing Address - Fax:225-761-6760
Practice Address - Street 1:6141 PARKFOREST DR
Practice Address - Street 2:SUITE 11
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6111
Practice Address - Country:US
Practice Address - Phone:225-751-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3522101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health