Healthcare Provider Details

I. General information

NPI: 1215660063
Provider Name (Legal Business Name): KIMBERLY DANIELLE DONNELLY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KIMBERLY DANIELLE SOLA

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132D CAPE HENRY RD APT D
VIRGINIA BEACH VA
23451-8093
US

IV. Provider business mailing address

3000 S ADAMS ST APT 1012
TALLAHASSEE FL
32301-6946
US

V. Phone/Fax

Practice location:
  • Phone: 252-424-9148
  • Fax:
Mailing address:
  • Phone: 252-424-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003927
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: