Individual
DESIREE MACDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3904 OLEANDER DR, SUITE 102, WILMINGTON, NC 28403-6735
(910) 313-3232
Mailing address
3904 OLEANDER DR STE 102, WILMINGTON, NC 28403-6735
(910) 313-3232
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100019021243
—
MA
Enumeration date
07/24/2018
Last updated
07/24/2018
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