Provider Demographics
NPI:1235658394
Name:RAMSEY, HARTATI DONNA (LISAC)
Entity Type:Individual
Prefix:MS
First Name:HARTATI DONNA
Middle Name:
Last Name:RAMSEY
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISAC
Mailing Address - Street 1:3256 W ANGELA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-6606
Mailing Address - Country:US
Mailing Address - Phone:480-341-6274
Mailing Address - Fax:
Practice Address - Street 1:3256 W ANGELA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-6606
Practice Address - Country:US
Practice Address - Phone:480-341-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC11816101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)