Provider Demographics
NPI:1922581974
Name:PURDY, TRINA LANETTE (BCBA)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:LANETTE
Last Name:PURDY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:
Other - Last Name:NIZNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16409 NORTHCROSS DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5065
Practice Address - Country:US
Practice Address - Phone:704-960-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician