Provider Demographics
NPI:1467415828
Name:MAUCK, DONNA KELLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:KELLEY
Last Name:MAUCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:241 GREENHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-3717
Mailing Address - Country:US
Mailing Address - Phone:540-463-3141
Mailing Address - Fax:540-464-4051
Practice Address - Street 1:241 GREENHOUSE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3717
Practice Address - Country:US
Practice Address - Phone:540-463-3141
Practice Address - Fax:540-464-4051
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710001198101YA0400X
VA09040042911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
009276R71Medicare PIN