Provider Demographics
NPI:1013513696
Name:DONALDSON, RAEANA SHANTE
Entity Type:Individual
Prefix:
First Name:RAEANA
Middle Name:SHANTE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2688 BARKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-3723
Mailing Address - Country:US
Mailing Address - Phone:269-216-1713
Mailing Address - Fax:
Practice Address - Street 1:350 E MICHIGAN AVE STE 20
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3848
Practice Address - Country:US
Practice Address - Phone:269-598-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801105600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker