Provider Demographics
NPI:1376108886
Name:WEST, CHRISTINA JULIA (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:JULIA
Last Name:WEST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:J
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:203 GREGSON DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6495
Mailing Address - Country:US
Mailing Address - Phone:919-461-0600
Mailing Address - Fax:
Practice Address - Street 1:203 GREGSON DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6495
Practice Address - Country:US
Practice Address - Phone:919-461-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-34238103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-34238OtherBACB