Provider Demographics
NPI:1285054882
Name:STEVENS, DIANDRA (BCBA)
Entity type:Individual
Prefix:
First Name:DIANDRA
Middle Name:
Last Name:STEVENS
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 1:125 WATKINS RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-1056
Mailing Address - Country:US
Mailing Address - Phone:937-218-4845
Mailing Address - Fax:513-847-4763
Practice Address - Street 1:125 WATKINS RD
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-1056
Practice Address - Country:US
Practice Address - Phone:937-218-4845
Practice Address - Fax:937-625-4357
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.162103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty