Provider Demographics
NPI:1396242319
Name:DONOVAN, BETHANY NICOLE (MA)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:NICOLE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 BUCKNELL CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4420
Mailing Address - Country:US
Mailing Address - Phone:309-838-0152
Mailing Address - Fax:
Practice Address - Street 1:6350 CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4107
Practice Address - Country:US
Practice Address - Phone:309-838-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health