Provider Demographics
NPI:1821655804
Name:SCHMIDT, DONALD (LCSW)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:SCHMIDT
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 1:1120 COBBLESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-3205
Mailing Address - Country:US
Mailing Address - Phone:203-936-7602
Mailing Address - Fax:
Practice Address - Street 1:61 FORSYTH ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-8931
Practice Address - Country:US
Practice Address - Phone:301-273-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051528-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR051528-1OtherLCSW