Individual
ELIZABETH DONOVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
3904 OLD VINEYARD RD, WINSTON SALEM, NC 27104-4740
(336) 251-1180
(336) 251-1181
Mailing address
3904 OLD VINEYARD RD, WINSTON SALEM, NC 27104-4740
(336) 251-1180
(336) 251-1181
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
122977
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1222977
BCABA
—
Enumeration date
09/24/2013
Last updated
09/24/2013
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