Healthcare Provider Details

I. General information

NPI: 1114112133
Provider Name (Legal Business Name): DELILA S DONALDSON LCSW, CAC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG / RAF LAKENHEATH OPC 41 BOX 15
APO AE
09461
GB

IV. Provider business mailing address

48 MDG / RAF LAKENHEATH OPC 41 BOX 15
APO AE
09461
GB

V. Phone/Fax

Practice location:
  • Phone: 314-226-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC-4913
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-869
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7749
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: