Provider Demographics
NPI:1316400682
Name:BLANKENSHIP, ALEXIS (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:6326 WIMBLEDON CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5900
Mailing Address - Country:US
Mailing Address - Phone:410-980-5795
Mailing Address - Fax:
Practice Address - Street 1:1010 WAYNE AVE STE 675
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5676
Practice Address - Country:US
Practice Address - Phone:240-292-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MD1-21-49705103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician