Provider Demographics
NPI:1487044707
Name:CARADINE, MALLORIE HUTTON (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MALLORIE
Middle Name:HUTTON
Last Name:CARADINE
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 1:4905 HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5630
Mailing Address - Country:US
Mailing Address - Phone:901-412-8678
Mailing Address - Fax:
Practice Address - Street 1:4905 HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5630
Practice Address - Country:US
Practice Address - Phone:901-412-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst