Provider Demographics
NPI:1215636857
Name:FISHTORN, ALANA NICHOLE (BCABA)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:NICHOLE
Last Name:FISHTORN
Suffix:
Gender:
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 SCARLET OAK RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-5816
Mailing Address - Country:US
Mailing Address - Phone:864-431-8065
Mailing Address - Fax:
Practice Address - Street 1:781 SCARLET OAK RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-5816
Practice Address - Country:US
Practice Address - Phone:864-431-8065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0-25-15981103K00000X
SCRBT-20-124334106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician