Provider Demographics
NPI:1235207119
Name:SOUTHWORTH, DONNA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:B
Last Name:SOUTHWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:SOUTHWORTH OGILVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2371
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2371
Mailing Address - Country:US
Mailing Address - Phone:615-370-8473
Mailing Address - Fax:615-370-8433
Practice Address - Street 1:7003 CHADWICK DR
Practice Address - Street 2:STE 153
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-370-8473
Practice Address - Fax:615-370-8433
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0008531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0122967OtherBCBS
0122967OtherBCBS