Provider Demographics
NPI:1184965030
Name:CULLIVAN, CHRISTA HOMLITAS (MS, BCBA)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:HOMLITAS
Last Name:CULLIVAN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:HOMLITAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:950 WINDHAM COURT
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-629-2955
Mailing Address - Fax:
Practice Address - Street 1:950 WINDHAM CT
Practice Address - Street 2:SUITE 4
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5083
Practice Address - Country:US
Practice Address - Phone:330-629-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-11-9618103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst