Provider Demographics
NPI:1881406841
Name:POLYNICE, KEMISSA NATHANAELLE (BCBA)
Entity type:Individual
Prefix:
First Name:KEMISSA
Middle Name:NATHANAELLE
Last Name:POLYNICE
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 1:522 BRADBURN VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1986
Mailing Address - Country:US
Mailing Address - Phone:615-810-1897
Mailing Address - Fax:
Practice Address - Street 1:401 S MOUNT JULIET RD STE 235
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8473
Practice Address - Country:US
Practice Address - Phone:703-564-1648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1756103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst