Provider Demographics
NPI:1053747089
Name:HARRISON, CYNTHIA SUSAN (BCBA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUSAN
Last Name:HARRISON
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 1:807 DONNELL BLVD STE Q
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-2111
Mailing Address - Country:US
Mailing Address - Phone:334-333-1330
Mailing Address - Fax:
Practice Address - Street 1:807 DONNELL BLVD STE Q
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-2111
Practice Address - Country:US
Practice Address - Phone:334-333-1330
Practice Address - Fax:334-709-4386
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3464103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst