1487768495 NPI number — MS. DONNA L HAVENS LCSW

Table of content: MS. DONNA L HAVENS LCSW (NPI 1487768495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487768495 NPI number — MS. DONNA L HAVENS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAVENS
Provider First Name:
DONNA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487768495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12301 GRAPEFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASTIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-688-4331
Provider Business Mailing Address Fax Number:
276-688-4336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12301 GRAPEFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASTIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-688-4331
Provider Business Practice Location Address Fax Number:
276-688-4336
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904001753 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 032113 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 247838 . This is a "MTN STATE BC/BC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010383277 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2121987 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 257838 . This is a "ANTHEM BC &BS" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
  • Identifier: 257838 . This is a "TRIGON HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 463014 . This is a "ALLIANCE/MAPSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005410916 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008963312 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171900 . This is a "COMPSYCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 257838 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8957010 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 156228 . This is a "VA, DEPT. REHAB. SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 200101 . This is a "MHN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 01843900 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541999431101 . This is a "JOHN DEERE (UBH)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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