Basic Information
| Provider Information | |||||||||
| NPI: | 1851927305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEATH | ||||||||
| FirstName: | CHRISTI | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | ABA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 VERNEY DR | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030475000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038313091 | ||||||||
| FaxNumber: | 6034101105 | ||||||||
| Practice Location | |||||||||
| Address1: | 580 LACONIA RD | ||||||||
| Address2: | |||||||||
| City: | TILTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032765321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038313091 | ||||||||
| FaxNumber: | 6034101105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2020 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.