Provider Demographics
NPI:1598111528
Name:MASHIA, DONNA (MED)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MASHIA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:576 BELLE TERRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-1715
Mailing Address - Country:US
Mailing Address - Phone:318-614-7644
Mailing Address - Fax:
Practice Address - Street 1:576 BELLE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1715
Practice Address - Country:US
Practice Address - Phone:318-614-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health