Provider Demographics
NPI:1942883178
Name:GILES, CRISTIE SHALEIGH (BCBA)
Entity Type:Individual
Prefix:
First Name:CRISTIE
Middle Name:SHALEIGH
Last Name:GILES
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:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518-0415
Mailing Address - Country:US
Mailing Address - Phone:205-919-2517
Mailing Address - Fax:
Practice Address - Street 1:13551 SAINT STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518
Practice Address - Country:US
Practice Address - Phone:205-919-2517
Practice Address - Fax:251-847-3080
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AL103K00000X
1-21-49622103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst