Provider Demographics
NPI:1689164709
Name:ALBERT, NADIA OLIVIA (BCBA)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:OLIVIA
Last Name:ALBERT
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 1:146 TIMBER CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4396
Mailing Address - Country:US
Mailing Address - Phone:912-508-2227
Mailing Address - Fax:
Practice Address - Street 1:8066 WALNUT RUN RD STE 102
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8842
Practice Address - Country:US
Practice Address - Phone:901-249-7838
Practice Address - Fax:901-271-7180
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN507103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-36342OtherBOARD CERTIFIED BEHAVIOR ANALYST
TNQ054050Medicaid