Provider Demographics
NPI:1841763422
Name:CULBERTSON, KENNETH DAVID (BCBA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:DAVID
Last Name:CULBERTSON
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LOWER MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY FACE
Mailing Address - State:GA
Mailing Address - Zip Code:30740-3202
Mailing Address - Country:US
Mailing Address - Phone:618-309-2681
Mailing Address - Fax:
Practice Address - Street 1:177 MOUSE CREEK RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3838
Practice Address - Country:US
Practice Address - Phone:423-212-3663
Practice Address - Fax:706-780-1705
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TB0200X
FLRBT-18-73414106S00000X
TN1-25-79013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician