Provider Demographics
NPI:1366504409
Name:DONALDSON, RICHARD LLOYD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LLOYD
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W MONTE VISTA AVE
Mailing Address - Street 2:SUITE A-1, #172
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-8412
Mailing Address - Country:US
Mailing Address - Phone:209-402-9645
Mailing Address - Fax:209-667-5325
Practice Address - Street 1:134 REGIS ST
Practice Address - Street 2:SUITE D
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1130
Practice Address - Country:US
Practice Address - Phone:209-402-9645
Practice Address - Fax:209-667-5325
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 153961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10OtherBEHAVIORAL HEALTH PROVIDE