Individual provider Active NPI

Donnetta Lafaye Graham, MSW, LCSW

  • Clinical Social Worker
  • Charlotte, NC
National Provider Identifier
1932514601
Registry record updated Jul 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C012891 Issued in NC
Practice address
10150 Mallard Creek Rd Ste 104
Charlotte, NC 28262-4567
Phone
(980) 242-7090
Fax
(980) 556-7219
NPI assigned
Jun 21, 2014
Last updated
Jul 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X P12112 NC
Clinical Social Worker 1041C0700X C012891 NC Primary

Addresses

Primary practice location

10150 Mallard Creek Rd Ste 104
Charlotte, NC 28262-4567

Mailing address

10150 Mallard Creek Rd Ste 104
Charlotte, NC 28262-4567
Phone (980) 242-7090

Other practice location 1

2404 Sandy River Ln Apt 103
Charlotte, NC 28273-4875
Phone (910) 431-6163

Other names 1

  • Donnetta Lafaye Evans Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200415003103 NC Practitioner - Clinical Social Worker 5496185456 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C012891NCMDClinical Social Worker
P12112NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Journey to Your Destiny, PLLC Clinical CurrentSince Jan 31, 2022 Accepting new patients
Good Stress Company PLLC CurrentSince Feb 20, 2020 Accepting new patients

Locations

10150 Mallard Creek Rd
Ste 104
Charlotte, NC 28262
Phone (980) 242-7090

1909 J N Pease Pl
Ste 201
Charlotte, NC 28262
Phone (704) 548-8250

6241 South Blvd
Unit 241883
Charlotte, NC 28224

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1932514601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10150 MALLARD CREEK RD STE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624567",
            "telephone_number": "980-242-7090",
            "fax_number": "980-556-7219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10150 MALLARD CREEK RD STE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624567",
            "telephone_number": "980-242-7090",
            "fax_number": "980-556-7219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2404 Sandy River Ln Apt 103",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282734875",
            "country_code": "US",
            "telephone_number": "910-431-6163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "DONNETTA",
        "middle_name": "LAFAYE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-21",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P12112",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DONNETTA",
            "last_name": "EVANS",
            "middle_name": "LAFAYE",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.