Provider Demographics
NPI:1548628670
Name:DONAHUE, ANDREW (BCBA; LBA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:BCBA; LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S JUTEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1210
Mailing Address - Country:US
Mailing Address - Phone:714-760-7840
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2096
Practice Address - Country:US
Practice Address - Phone:808-591-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
HIBA327103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other