Provider Demographics
NPI:1275246878
Name:DONNELLY, VANESSA (RBT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9276 GARRETT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4385
Mailing Address - Country:US
Mailing Address - Phone:912-373-4483
Mailing Address - Fax:
Practice Address - Street 1:200 BROOKSTONE CENTRE PKWY BLDG 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4559
Practice Address - Country:US
Practice Address - Phone:762-239-0017
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GARBT-22-232707106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician