Provider Demographics
NPI:1518031921
Name:TOHL -SANTIAGO, DONNA (LCSW R, LISW-CP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:TOHL -SANTIAGO
Suffix:
Gender:F
Credentials:LCSW R, LISW-CP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:TOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4603 OLEANDER DR
Mailing Address - Street 2:SUITES 1&2
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5738
Mailing Address - Country:US
Mailing Address - Phone:843-497-5240
Mailing Address - Fax:843-497-1129
Practice Address - Street 1:4603 OLEANDER DR
Practice Address - Street 2:SUITES 1&2
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5738
Practice Address - Country:US
Practice Address - Phone:843-497-5240
Practice Address - Fax:843-497-1129
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04139911041C0700X
SC100391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical