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NPI Code Detail

MEDICARE: ZYVIERA SHAINECE BALLOU MA, BCBA

MEDICARE: ZYVIERA SHAINECE BALLOU MA, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-21-51147FL
3171M00000XCase Manager/Care CoordinatorCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447750328
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZYVIERA SHAINECE BALLOU MA, BCBA
Provider Business Mailing Address
First Line : 2814 PROCUREMENT CIR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-4852
Country : US
Telephone Number : 855-772-8847
Fax Number :
Provider Business Practice Location Address
First Line : 1410 CUSTER AVE SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-3304
Country : US
Telephone Number : 855-772-8847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2018
Last Update Date : 03/04/2026

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