Provider Demographics
NPI:1376037655
Name:BROTHERS, DONESHA (LCSW)
Entity Type:Individual
Prefix:
First Name:DONESHA
Middle Name:
Last Name:BROTHERS
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 1:216 CLAREMONT CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9024
Mailing Address - Country:US
Mailing Address - Phone:252-331-9596
Mailing Address - Fax:
Practice Address - Street 1:905 HALSTEAD BLVD STE 18
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6816
Practice Address - Country:US
Practice Address - Phone:252-618-6143
Practice Address - Fax:252-616-4847
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040126431041C0700X
NCC0128521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty