Healthcare Provider Details

I. General information

NPI: 1255719332
Provider Name (Legal Business Name): MADELINE ELAINE MCDONOUGH M.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 SE BROAD ST STE A&B
SOUTHERN PINES NC
28387-6057
US

IV. Provider business mailing address

375 SE BROAD ST STE A&B
SOUTHERN PINES NC
28387-6057
US

V. Phone/Fax

Practice location:
  • Phone: 980-360-8989
  • Fax: 954-342-6481
Mailing address:
  • Phone: 980-360-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4471
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: