Provider Demographics
NPI:1912681032
Name:TINDLE, DONOVAN (RBT)
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:
Last Name:TINDLE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 COUNTY ROAD 520
Mailing Address - Street 2:
Mailing Address - City:NEW BROCKTON
Mailing Address - State:AL
Mailing Address - Zip Code:36351-5010
Mailing Address - Country:US
Mailing Address - Phone:334-766-1629
Mailing Address - Fax:
Practice Address - Street 1:2543 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4925
Practice Address - Country:US
Practice Address - Phone:334-699-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23-261937106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty