Provider Demographics
NPI:1801470448
Name:SPROLES, KRISTIN DANIELLE (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DANIELLE
Last Name:SPROLES
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 1:1657 E STONE DR STE B
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4669
Mailing Address - Country:US
Mailing Address - Phone:423-375-9192
Mailing Address - Fax:833-379-4405
Practice Address - Street 1:2020 MEADOWVIEW PKWY STE 110
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7388
Practice Address - Country:US
Practice Address - Phone:423-375-9192
Practice Address - Fax:833-379-4405
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN792103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst