Provider Demographics
NPI:1730433251
Name:JACKSON-ARREDONDO, DONNA (LGSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:JACKSON-ARREDONDO
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-7750
Mailing Address - Country:US
Mailing Address - Phone:256-794-2593
Mailing Address - Fax:
Practice Address - Street 1:3454 CAMPGROUND RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-7750
Practice Address - Country:US
Practice Address - Phone:256-794-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2805G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical