Provider Demographics
NPI:1942787858
Name:DONALD, MAKENCIE (BCBA)
Entity Type:Individual
Prefix:
First Name:MAKENCIE
Middle Name:
Last Name:DONALD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SPRING FALLS CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-7101
Mailing Address - Country:US
Mailing Address - Phone:803-414-2428
Mailing Address - Fax:864-999-2090
Practice Address - Street 1:104 COMMONS BLVD STE B
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7766
Practice Address - Country:US
Practice Address - Phone:864-513-3334
Practice Address - Fax:864-999-2090
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0-19-9602106E00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst