Provider Demographics
NPI:1427587021
Name:HIATT, RITA MICHELE (BCBA)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MICHELE
Last Name:HIATT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:MICHELE
Other - Last Name:PRUZANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:6795 CAPSTONE CT
Mailing Address - Street 2:
Mailing Address - City:RURAL HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27045-9951
Mailing Address - Country:US
Mailing Address - Phone:954-864-9427
Mailing Address - Fax:
Practice Address - Street 1:241 GARRISONVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1555
Practice Address - Country:US
Practice Address - Phone:703-986-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26828103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst