Provider Demographics
NPI:1598238982
Name:WHEELER, TIFFANY JOY (BCBA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JOY
Last Name:WHEELER
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 1:4165 BALLINA DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5304
Mailing Address - Country:US
Mailing Address - Phone:678-886-4173
Mailing Address - Fax:
Practice Address - Street 1:4165 BALLINA DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5304
Practice Address - Country:US
Practice Address - Phone:678-886-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst