Provider Demographics
NPI:1720537376
Name:HABINA, BRANDI M (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:M
Last Name:HABINA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:M
Other - Last Name:BEHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:181 W PROFESSIONAL PARK COURT
Mailing Address - Street 2:STE 1
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42014-3250
Mailing Address - Country:US
Mailing Address - Phone:270-843-5300
Mailing Address - Fax:270-843-5300
Practice Address - Street 1:4323 OLD MILL RD STE B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1117
Practice Address - Country:US
Practice Address - Phone:803-905-4431
Practice Address - Fax:803-905-4427
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000800-1103K00000X
SC1-14-17870103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst