Provider Demographics
NPI:1114339488
Name:LONICH, AYSHA MAE (BCBA)
Entity Type:Individual
Prefix:
First Name:AYSHA
Middle Name:MAE
Last Name:LONICH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AYSHA
Other - Middle Name:MAE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1931 GOLDEN GLOBE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-4503
Mailing Address - Country:US
Mailing Address - Phone:724-554-3801
Mailing Address - Fax:
Practice Address - Street 1:3739 NATIONAL DR STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4817
Practice Address - Country:US
Practice Address - Phone:919-502-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
1-15-18610103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health