Provider Demographics
NPI:1972006641
Name:DIEHL, CANDISS NICHOLE (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:CANDISS
Middle Name:NICHOLE
Last Name:DIEHL
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 ABLE CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3100
Mailing Address - Country:US
Mailing Address - Phone:251-410-0160
Mailing Address - Fax:
Practice Address - Street 1:664 POWERS AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36205-4419
Practice Address - Country:US
Practice Address - Phone:256-847-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2018-042103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-29540OtherBEHAVIOR ANALYST CERTIFICATION BOARD
14647243OtherCAQH
AL2018-042OtherALABAMA BEHAVIOR ANALYST LICENSURE BOARD