Provider Demographics
NPI:1386041366
Name:JUSTICE, WILLIAM VAN III (BCBA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:VAN
Last Name:JUSTICE
Suffix:III
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 CULLY RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8502
Mailing Address - Country:US
Mailing Address - Phone:901-624-2454
Mailing Address - Fax:901-624-2928
Practice Address - Street 1:1155 CULLY RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8502
Practice Address - Country:US
Practice Address - Phone:901-624-2454
Practice Address - Fax:901-624-2928
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-9997103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst