Provider Demographics
NPI:1972961712
Name:DIBOS, JULIA KRISTINA (BCBA)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:KRISTINA
Last Name:DIBOS
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 1092
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-1092
Mailing Address - Country:US
Mailing Address - Phone:888-547-2250
Mailing Address - Fax:
Practice Address - Street 1:58 FOLLY ROAD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7582
Practice Address - Country:US
Practice Address - Phone:888-547-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-15-21159103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst