Provider Demographics
NPI:1982869004
Name:MOON, DONA
Entity type:Individual
Prefix:MS
First Name:DONA
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONA
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW, LCSW-C
Mailing Address - Street 1:15037 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5547
Mailing Address - Country:US
Mailing Address - Phone:240-461-8956
Mailing Address - Fax:240-461-8956
Practice Address - Street 1:7500 HANOVER PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2010
Practice Address - Country:US
Practice Address - Phone:240-461-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC03012104100000X, 1041C0700X
MD084961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD145120960Medicaid