Provider Demographics
NPI:1710593488
Name:SLABODA, DONNA DOLORES (CADC-II)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:DOLORES
Last Name:SLABODA
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATHAM
Mailing Address - State:GA
Mailing Address - Zip Code:30666-1547
Mailing Address - Country:US
Mailing Address - Phone:706-350-1078
Mailing Address - Fax:
Practice Address - Street 1:1 HUNTINGTON RD STE 704
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7215
Practice Address - Country:US
Practice Address - Phone:706-350-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA815101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)