Healthcare Provider Details

I. General information

NPI: 1215408323
Provider Name (Legal Business Name): DAWNIELLE MONIQUE GOODWIN MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WALPOLE ST STE 207
STAFFORD VA
22554-6546
US

IV. Provider business mailing address

137 PECK LN
SUFFOLK VA
23434-7678
US

V. Phone/Fax

Practice location:
  • Phone: 540-383-7133
  • Fax:
Mailing address:
  • Phone: 269-873-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: