Provider Demographics
NPI:1922541861
Name:DONNELL, TARSHIA (CDAC CCMA)
Entity Type:Individual
Prefix:
First Name:TARSHIA
Middle Name:
Last Name:DONNELL
Suffix:
Gender:F
Credentials:CDAC CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-0788
Mailing Address - Country:US
Mailing Address - Phone:336-669-8181
Mailing Address - Fax:
Practice Address - Street 1:204 MUIRS CHAPEL RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6174
Practice Address - Country:US
Practice Address - Phone:336-523-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-27
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
NCCSAC-14127101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)