Provider Demographics
NPI:1144504655
Name:DONELSON, DOROTHY ANNA MAE (LMSW)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANNA MAE
Last Name:DONELSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:ANNA MAE
Other - Last Name:LANTZ PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:15723 SMITH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAPLETON DEPOT
Mailing Address - State:PA
Mailing Address - Zip Code:17052
Mailing Address - Country:US
Mailing Address - Phone:870-735-4441
Mailing Address - Fax:870-735-5441
Practice Address - Street 1:4001 COMMERCIAL CENTER DR STE 2
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9616
Practice Address - Country:US
Practice Address - Phone:870-735-4441
Practice Address - Fax:870-735-5441
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2443-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical