Provider Demographics
NPI:1649829144
Name:SANTANA, BELLANICE MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:BELLANICE
Middle Name:MARIE
Last Name:SANTANA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BELLANICE
Other - Middle Name:MARIE
Other - Last Name:FRANCISCO-VAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:13523 PLAZA ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8921
Mailing Address - Country:US
Mailing Address - Phone:980-202-7428
Mailing Address - Fax:
Practice Address - Street 1:13523 PLAZA ROAD EXT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8921
Practice Address - Country:US
Practice Address - Phone:980-202-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NC694103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician