Provider Demographics
NPI:1740610443
Name:FANNIN, CHRISTINE AUSTIN (BCBA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:AUSTIN
Last Name:FANNIN
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 1:445 E. DUBLIN GRANVILLE RD
Mailing Address - Street 2:BUILDING G
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:614-436-6570
Practice Address - Street 1:445 E. DUBLIN GRANVILLE RD
Practice Address - Street 2:BUILDING G
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085
Practice Address - Country:US
Practice Address - Phone:614-436-7837
Practice Address - Fax:614-436-6570
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-13-12725103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst