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General NPI Number Information
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NPI Number | 1144915497
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Entity Type | Individual
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Provider Name | DOMINIQUE DESMOND FORD BCBA
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Gender | Male
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 9985 POPLAR TENT RO
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City | HUNTERSVILLE
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State | NC
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Zip | 28027
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Country | US
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Telephone | 704-774-8424
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Fax |
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Provider Business Mailing Address
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Address Line | 9985 POPLAR TENT RD HUNTERSVILLE,
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City | HUNTERSVILLE
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State | NC
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Zip | 28027
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Country | US
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Telephone | 704-774-8424
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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