Provider Demographics
NPI:1457616575
Name:WALLS-SUAREZ, CARRIE EILEEN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:EILEEN
Last Name:WALLS-SUAREZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:EILEEN
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:5818 WILMINGTON PIKE # 114
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7004
Mailing Address - Country:US
Mailing Address - Phone:937-308-7047
Mailing Address - Fax:937-343-6666
Practice Address - Street 1:5265 SECRETARIAT DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-5036
Practice Address - Country:US
Practice Address - Phone:937-308-7047
Practice Address - Fax:937-343-6666
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-11707103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH224OtherCERTIFIED OHIO BEHAVIOR ANALYST (COBA) NUMBER