Provider Demographics
NPI:1790940310
Name:DONALDSON, LAMAR FLOYD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LAMAR
Middle Name:FLOYD
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 TIGER BAY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-1063
Mailing Address - Country:US
Mailing Address - Phone:386-947-1300
Mailing Address - Fax:386-323-2274
Practice Address - Street 1:1220 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2810
Practice Address - Country:US
Practice Address - Phone:386-236-3200
Practice Address - Fax:386-236-3118
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000382600Medicaid