Provider Demographics
NPI:1114214632
Name:JAMES, PORTIA C (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:C
Last Name:JAMES
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 CAVA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8717
Mailing Address - Country:US
Mailing Address - Phone:909-749-5204
Mailing Address - Fax:
Practice Address - Street 1:8555 CAVA DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8717
Practice Address - Country:US
Practice Address - Phone:909-749-5204
Practice Address - Fax:909-774-0113
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8706103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-11-8706OtherBOARD CERTIFIED BEHAVIOR ANALYST