Healthcare Provider Details

I. General information

NPI: 1205950870
Provider Name (Legal Business Name): LASWANNA DONALDSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10372 COOPER RIDGE CV
CORDOVA TN
38016-7619
US

IV. Provider business mailing address

10372 COOPER RIDGE CV
CORDOVA TN
38016-7619
US

V. Phone/Fax

Practice location:
  • Phone: 901-361-4654
  • Fax:
Mailing address:
  • Phone: 901-361-4654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10056
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: