Provider Demographics
NPI:1114112133
Name:DONALDSON, DELILA S (LCSW, CAC III)
Entity Type:Individual
Prefix:
First Name:DELILA
Middle Name:S
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:LCSW, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0148
Mailing Address - Country:US
Mailing Address - Phone:541-366-8225
Mailing Address - Fax:877-775-1788
Practice Address - Street 1:2004 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-7339
Practice Address - Country:US
Practice Address - Phone:541-363-7650
Practice Address - Fax:877-775-1788
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC-4913101YA0400X
COCSW-8691041C0700X, 1041C0700X
ORL77491041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL7749OtherLCSW
OR500740695Medicaid