Provider Demographics
NPI:1194103408
Name:MAKRIDIS, DIMITRIOS (BCBA)
Entity type:Individual
Prefix:
First Name:DIMITRIOS
Middle Name:
Last Name:MAKRIDIS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 E MAIN ST STE B282
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3717
Mailing Address - Country:US
Mailing Address - Phone:937-470-5092
Mailing Address - Fax:
Practice Address - Street 1:3000 E MAIN ST STE B282
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3717
Practice Address - Country:US
Practice Address - Phone:937-470-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst