Provider Demographics
NPI:1619561842
Name:WASHINGTON, DONNETTA SHANTE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:DONNETTA
Middle Name:SHANTE
Last Name:WASHINGTON
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 1:1405 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-2050
Mailing Address - Country:US
Mailing Address - Phone:205-575-9303
Mailing Address - Fax:
Practice Address - Street 1:4550 JONESBORO RD STE A2-208
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2050
Practice Address - Country:US
Practice Address - Phone:205-575-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4963C1041C0700X
GACSW0075051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical