Provider Demographics
NPI:1831298710
Name:GREEN-GILMORE, DONYSIA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DONYSIA
Middle Name:MARIE
Last Name:GREEN-GILMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DONYSIA
Other - Middle Name:MARIE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 COSTA PACIFICA WAY
Mailing Address - Street 2:2107
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2195
Mailing Address - Country:US
Mailing Address - Phone:858-220-9006
Mailing Address - Fax:
Practice Address - Street 1:1930 S COAST HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6455
Practice Address - Country:US
Practice Address - Phone:858-220-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS212181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical