Provider Demographics
NPI:1386777233
Name:HAGUE, DONNA JO (LCSW 65625)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:HAGUE
Suffix:
Gender:F
Credentials:LCSW 65625
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JO
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW INTERN
Mailing Address - Street 1:PO BOX 2841
Mailing Address - Street 2:22620 POWHATAN RD
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0054
Mailing Address - Country:US
Mailing Address - Phone:760-247-0601
Mailing Address - Fax:
Practice Address - Street 1:22620 POWHATAN RD
Practice Address - Street 2:22620 POWHATAN RD
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-6637
Practice Address - Country:US
Practice Address - Phone:760-247-0601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA656251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical