Provider Demographics
NPI:1063984300
Name:BUFORD, ALYSSA ANN (BCBA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:BUFORD
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 1:1078 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4819
Mailing Address - Country:US
Mailing Address - Phone:912-272-7204
Mailing Address - Fax:
Practice Address - Street 1:1078 WELLINGTON CT
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4819
Practice Address - Country:US
Practice Address - Phone:912-272-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty