Provider Demographics
NPI:1629530068
Name:DILLENDER, HALEIGH ELISABETH (BCBA)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:ELISABETH
Last Name:DILLENDER
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 1:4647 CLYDE MORRIS BLVD UNIT 501
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-3001
Mailing Address - Country:US
Mailing Address - Phone:386-767-3752
Mailing Address - Fax:
Practice Address - Street 1:4647 CLYDE MORRIS BLVD UNIT 501
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-3001
Practice Address - Country:US
Practice Address - Phone:386-767-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-18-34352103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst