Provider Demographics
NPI:1407518590
Name:BUSBEE, HAVEN NICOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:HAVEN
Middle Name:NICOLE
Last Name:BUSBEE
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 1:2417 SEQUOIA TRL
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-0790
Mailing Address - Country:US
Mailing Address - Phone:843-461-0831
Mailing Address - Fax:
Practice Address - Street 1:224 THORNCREST DR
Practice Address - Street 2:
Practice Address - City:PAULINE
Practice Address - State:SC
Practice Address - Zip Code:29374-1626
Practice Address - Country:US
Practice Address - Phone:864-590-0485
Practice Address - Fax:864-727-1010
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-23-68792103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst