Provider Demographics
NPI:1356043350
Name:DAVIS, CHRISTINA ANITA (BCBA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANITA
Last Name:DAVIS
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 1:14415 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1907
Mailing Address - Country:US
Mailing Address - Phone:708-288-4487
Mailing Address - Fax:
Practice Address - Street 1:3235 VOLLMER RD STE 125
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2040
Practice Address - Country:US
Practice Address - Phone:708-914-4274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst