Provider Demographics
NPI:1710489539
Name:SANDERSON, AUBRIANA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AUBRIANA
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:AUBRIANA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:10175 FORTUNE PARKWAY STE 903
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6755
Mailing Address - Country:US
Mailing Address - Phone:904-538-0713
Mailing Address - Fax:904-538-0714
Practice Address - Street 1:1450 54TH ST STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-221-1208
Practice Address - Fax:706-221-1209
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-18-58430106S00000X
GA1-22-57902103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician