Provider Demographics
NPI:1033674858
Name:MAULDIN, JENNIFER SUE-LUCAS (BCBA, MS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUE-LUCAS
Last Name:MAULDIN
Suffix:
Gender:F
Credentials:BCBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12356 PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28128-7599
Mailing Address - Country:US
Mailing Address - Phone:704-438-2683
Mailing Address - Fax:
Practice Address - Street 1:12356 PRINCE RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NC
Practice Address - Zip Code:28128-7599
Practice Address - Country:US
Practice Address - Phone:704-438-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NC1-21-50843103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician