Provider Demographics
NPI:1497116834
Name:KNOX, STEPHANIE NICOLE (BCBA-D)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:KNOX
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8269 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1560
Mailing Address - Country:US
Mailing Address - Phone:706-304-1287
Mailing Address - Fax:
Practice Address - Street 1:8269 LANTERN LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-1560
Practice Address - Country:US
Practice Address - Phone:706-304-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-13
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01-14-17610103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13604699OtherCAQH