Provider Demographics
NPI:1215660063
Name:DONNELLY, KIMBERLY DANIELLE (RBT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DANIELLE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:DANIELLE
Other - Last Name:SOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 KAMOKILA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2096
Mailing Address - Country:US
Mailing Address - Phone:252-424-9148
Mailing Address - Fax:
Practice Address - Street 1:9030 BORDELON LOOP
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-5438
Practice Address - Country:US
Practice Address - Phone:252-424-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician