Provider Demographics
NPI:1538185772
Name:BARTLETT, DONNA RAE (MSW LCSW CMHT)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:RAE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:MSW LCSW CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2233
Mailing Address - Country:US
Mailing Address - Phone:919-412-8046
Mailing Address - Fax:919-859-2780
Practice Address - Street 1:621 S LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2233
Practice Address - Country:US
Practice Address - Phone:919-412-8046
Practice Address - Fax:919-859-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004214104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133UKOtherBLUE CROSS BLUE SHIELD
NC6106251Medicaid