Provider Demographics
NPI:1063666006
Name:DEWITT, NICOLE JOY (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JOY
Last Name:DEWITT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:JOY
Other - Last Name:HOFFMEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:118 1/2 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-1737
Mailing Address - Country:US
Mailing Address - Phone:248-830-4035
Mailing Address - Fax:
Practice Address - Street 1:2505 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2635
Practice Address - Country:US
Practice Address - Phone:574-289-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst