Provider Demographics
NPI:1760818371
Name:DONALSON, ROSEMARY GRIFFIN (MPH)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:GRIFFIN
Last Name:DONALSON
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:GRIFFIN DONALSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 MOSS WAY
Mailing Address - Street 2:APT 3
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5442
Mailing Address - Country:US
Mailing Address - Phone:510-533-0800
Mailing Address - Fax:
Practice Address - Street 1:1124 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-4331
Practice Address - Country:US
Practice Address - Phone:510-533-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA29821103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)