Provider Demographics
NPI:1114270535
Name:DONALDSON, THERESA P (LICSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:P
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:P
Other - Last Name:DONALDSON-DEPASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:35 K ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4216
Mailing Address - Country:US
Mailing Address - Phone:202-442-4876
Mailing Address - Fax:202-727-0857
Practice Address - Street 1:35 K ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4216
Practice Address - Country:US
Practice Address - Phone:202-442-4876
Practice Address - Fax:202-727-0857
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3002961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical