Provider Demographics
NPI:1629552716
Name:SALLIS, NINA MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:MARIE
Last Name:SALLIS
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 1:2024 ROSEBURY LN SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1412
Mailing Address - Country:US
Mailing Address - Phone:256-503-8946
Mailing Address - Fax:
Practice Address - Street 1:4769 WHITESBURG DR SE STE 202
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1684
Practice Address - Country:US
Practice Address - Phone:256-666-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst