Provider Demographics
NPI:1487861985
Name:TRAVIS, DONNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:TRAVIS
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:PO BOX 6071
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-0001
Mailing Address - Country:US
Mailing Address - Phone:704-661-1730
Mailing Address - Fax:704-743-2130
Practice Address - Street 1:821 REGENCY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5420
Practice Address - Country:US
Practice Address - Phone:704-743-2105
Practice Address - Fax:704-743-2130
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0014781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical