Provider Demographics
NPI:1255310892
Name:DONNER, GOLDYE P (LCSW)
Entity Type:Individual
Prefix:
First Name:GOLDYE
Middle Name:P
Last Name:DONNER
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 1:6120 BRANDON AVE
Mailing Address - Street 2:STE116
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150
Mailing Address - Country:US
Mailing Address - Phone:703-569-6492
Mailing Address - Fax:703-569-0428
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:#116
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2522
Practice Address - Country:US
Practice Address - Phone:703-569-6492
Practice Address - Fax:703-569-0428
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040000681041C0700X
DCLC3000651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC641444Medicare PIN