Provider Demographics
NPI:1487768495
Name:HAVENS, DONNA L (LCSW)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:L
Last Name:HAVENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 GRAPEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BASTIAN
Mailing Address - State:VA
Mailing Address - Zip Code:24314
Mailing Address - Country:US
Mailing Address - Phone:276-688-4331
Mailing Address - Fax:276-688-4336
Practice Address - Street 1:12301 GRAPEFIELD RD
Practice Address - Street 2:
Practice Address - City:BASTIAN
Practice Address - State:VA
Practice Address - Zip Code:24314
Practice Address - Country:US
Practice Address - Phone:276-688-4331
Practice Address - Fax:276-688-4336
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040017531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA032113OtherVALUE OPTIONS
VA247838OtherMTN STATE BC/BC
VA010383277Medicaid
VA2121987OtherMAMSI
VI257838OtherANTHEM BC &BS
VA257838OtherTRIGON HEALTHKEEPERS
VA463014OtherALLIANCE/MAPSI
VA005410916Medicaid
VA008963312Medicaid
VA171900OtherCOMPSYCH
VA257838OtherBLUE CROSS BLUE SHIELD
VA8957010OtherCIGNA
VA156228OtherVA, DEPT. REHAB. SERVICES
VA200101OtherMHN
VA01843900OtherMAGELLAN
VA541999431101OtherJOHN DEERE (UBH)
VA156228OtherVA, DEPT. REHAB. SERVICES
VA005410916Medicaid