Provider Demographics
NPI:1619386703
Name:STALLINGS, MIRA NICOLE (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MIRA
Middle Name:NICOLE
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:MS, BCBA
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Mailing Address - Street 1:2171 FOSTER SPROUSE RD
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-6918
Mailing Address - Country:US
Mailing Address - Phone:706-691-4729
Mailing Address - Fax:706-843-6294
Practice Address - Street 1:3633 WHEELER RD STE 320
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6552
Practice Address - Country:US
Practice Address - Phone:706-691-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2023-06-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst