Provider Demographics
NPI:1124585906
Name:GRIFFIS, NICOLE LYDIA (BCBA)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LYDIA
Last Name:GRIFFIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 SNAPFINGER PARK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4044
Mailing Address - Country:US
Mailing Address - Phone:877-288-4760
Mailing Address - Fax:404-600-1259
Practice Address - Street 1:1229 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3527
Practice Address - Country:US
Practice Address - Phone:850-215-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-78197106S00000X
FLBACB480828103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician