Provider Demographics
NPI:1790966281
Name:HARDAWAY, DONNIE WAYNE
Entity Type:Individual
Prefix:MR
First Name:DONNIE
Middle Name:WAYNE
Last Name:HARDAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 FAVOR ST
Mailing Address - Street 2:APT C
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3155
Mailing Address - Country:US
Mailing Address - Phone:510-784-5889
Mailing Address - Fax:510-784-9194
Practice Address - Street 1:7105 FAVOR ST
Practice Address - Street 2:APT C
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-3155
Practice Address - Country:US
Practice Address - Phone:510-784-5889
Practice Address - Fax:510-784-9194
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)