Provider Demographics
NPI:1720035629
Name:PREUSSER, DONIELLE MARIA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONIELLE
Middle Name:MARIA
Last Name:PREUSSER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WALNUT ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4063
Mailing Address - Country:US
Mailing Address - Phone:910-815-6699
Mailing Address - Fax:910-343-4227
Practice Address - Street 1:313 WALNUT ST
Practice Address - Street 2:SUITE 111
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4063
Practice Address - Country:US
Practice Address - Phone:910-815-6699
Practice Address - Fax:910-343-4227
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1340TOtherBLUE CROSS BLUE SHIELD
NC6002695Medicaid
NC1340TOtherBLUE CROSS BLUE SHIELD