Provider Demographics
NPI:1316588973
Name:GIDDINGS, MICHELLE M (BCABA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:GIDDINGS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 OAK PL APT C
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2016
Mailing Address - Country:US
Mailing Address - Phone:352-638-0902
Mailing Address - Fax:
Practice Address - Street 1:630 N WILD OLIVE AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-3862
Practice Address - Country:US
Practice Address - Phone:386-603-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-22-13928106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst