Provider Demographics
NPI:1215408323
Name:GOODWIN, DAWNIELLE MONIQUE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:DAWNIELLE
Middle Name:MONIQUE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PECK LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-7678
Mailing Address - Country:US
Mailing Address - Phone:269-873-3293
Mailing Address - Fax:
Practice Address - Street 1:35 WALPOLE ST STE 207
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6546
Practice Address - Country:US
Practice Address - Phone:540-383-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X, 103K00000X, 106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst