Provider Demographics
NPI:1639838709
Name:LINDER, MICHELE VIRGINIA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:VIRGINIA
Last Name:LINDER
Suffix:
Gender:
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:VANRYSDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:277 SAWMILL LANDING DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-0388
Mailing Address - Country:US
Mailing Address - Phone:904-687-4012
Mailing Address - Fax:
Practice Address - Street 1:12724 GRAN BAY PKWY W STE 410
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-9486
Practice Address - Country:US
Practice Address - Phone:904-687-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-195646106S00000X
FL1-25-80867103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician