Healthcare Provider Details

I. General information

NPI: 1558003731
Provider Name (Legal Business Name): NATHANIEL HUNTER HENDRICKS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LE PHILLIP CT NE
CONCORD NC
28025-2900
US

IV. Provider business mailing address

209 7TH ST FL 3
AUGUSTA GA
30901-1486
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-5330
  • Fax: 706-842-5340
Mailing address:
  • Phone: 706-842-5330
  • Fax: 706-842-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81511
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: