Provider Demographics
NPI:1548457096
Name:SHAVERS, DONNA DELORES (MSW, P-LCSW)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:DELORES
Last Name:SHAVERS
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ELM DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-2131
Mailing Address - Country:US
Mailing Address - Phone:336-767-6498
Mailing Address - Fax:
Practice Address - Street 1:1001 S MARSHALL ST
Practice Address - Street 2:SUITE 182
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5852
Practice Address - Country:US
Practice Address - Phone:336-722-8055
Practice Address - Fax:336-722-8188
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0023331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical