Healthcare Provider Details

I. General information

NPI: 1417840620
Provider Name (Legal Business Name): LAKISHA DONERSON CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 WARRENSVILLE CENTER RD
MAPLE HEIGHTS OH
44137-1915
US

IV. Provider business mailing address

17325 EUCLID AVE STE 3144
CLEVELAND OH
44112-1256
US

V. Phone/Fax

Practice location:
  • Phone: 216-773-1877
  • Fax:
Mailing address:
  • Phone: 216-773-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: