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General NPI Number Information
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NPI Number | 1124585906
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Entity Type | Individual
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Provider Name | NICOLE LYDIA GRIFFIS BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 1229 AIRPORT RD
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City | PANAMA CITY
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State | FL
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Zip | 32405-3527
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Country | US
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Telephone | 850-215-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 5280 SNAPFINGER PARK DR
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City | DECATUR
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State | GA
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Zip | 30035-4044
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Country | US
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Telephone | 877-288-4760
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Fax | 404-600-1259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-78197
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB480828
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License Number State | FL
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