Provider Demographics
NPI:1972903698
Name:MARTIN, CHRISTI LEE BROCK (BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:LEE BROCK
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:LEE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10221 FORD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-0259
Mailing Address - Country:US
Mailing Address - Phone:912-445-6063
Mailing Address - Fax:912-445-6064
Practice Address - Street 1:10221 FORD AVE STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-0259
Practice Address - Country:US
Practice Address - Phone:912-445-6063
Practice Address - Fax:912-445-6064
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-21443103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst