Provider Demographics
NPI:1811547235
Name:WILCOX, CATHERINE CHRISTINE (BCABA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:CHRISTINE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 VENETIAN BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-4229
Mailing Address - Country:US
Mailing Address - Phone:727-776-0277
Mailing Address - Fax:
Practice Address - Street 1:4961 VENETIAN BLVD NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-4229
Practice Address - Country:US
Practice Address - Phone:727-776-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty