Provider Demographics
NPI:1902303548
Name:SALTER, TINA (BCBA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SALTER
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 1:1869 WILKINSON RD NE
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-7357
Mailing Address - Country:US
Mailing Address - Phone:122-681-7179
Mailing Address - Fax:
Practice Address - Street 1:1869 WILKINSON RD NE
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-7357
Practice Address - Country:US
Practice Address - Phone:912-268-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst