Provider Demographics
NPI:1821237439
Name:DONELL, LYDIA (BCBA, SLP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:DONELL
Suffix:
Gender:F
Credentials:BCBA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-430-9259
Mailing Address - Fax:803-905-4431
Practice Address - Street 1:120 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-3904
Practice Address - Country:US
Practice Address - Phone:864-430-9259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
SC4614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst