=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396929055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDYE P DONNER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2007
-----------------------------------------------------
Last Update Date | 04/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6120 BRANDON AVE STE 116
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22150-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-569-6492
-----------------------------------------------------
Fax | 703-569-0428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6120 BRANDON AVE STE 116
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22150-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-569-6492
-----------------------------------------------------
Fax | 703-569-0428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GOLDYE PERRIN DONNER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 703-569-6492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904000068
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------