Provider Demographics
NPI:1184243073
Name:DONALDSON, DAVID SHANE (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SHANE
Last Name:DONALDSON
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 1:1873 RAINTREE CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2117
Mailing Address - Country:US
Mailing Address - Phone:404-889-6223
Mailing Address - Fax:
Practice Address - Street 1:2386 CLOWER ST STE D102
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6108
Practice Address - Country:US
Practice Address - Phone:404-889-6223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0070611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical