Provider Demographics
NPI:1194336370
Name:SMALL, LINDSAY JEANNE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:JEANNE
Last Name:SMALL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:JEANNE
Other - Last Name:GAYNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:7304 GORMAN PL APT 7304
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-8129
Mailing Address - Country:US
Mailing Address - Phone:864-243-1022
Mailing Address - Fax:
Practice Address - Street 1:751 EAST GEORGIA ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388
Practice Address - Country:US
Practice Address - Phone:864-676-0028
Practice Address - Fax:864-476-0033
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst