Provider Demographics
NPI:1780123570
Name:STITES, DONNA (LISW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:STITES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 SIGLER RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-9553
Mailing Address - Country:US
Mailing Address - Phone:614-313-4080
Mailing Address - Fax:937-293-9455
Practice Address - Street 1:1349 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4925
Practice Address - Country:US
Practice Address - Phone:937-245-6108
Practice Address - Fax:937-599-2769
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1500752104100000X
OHI.21027331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker