Provider Demographics
NPI:1407518590
Name:BUSBEE, HAVEN NICOLE (BCBA)
Entity type:Individual
Prefix:
First Name:HAVEN
Middle Name:NICOLE
Last Name:BUSBEE
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 1:500 CONGAREE RD APT 7229
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4770
Mailing Address - Country:US
Mailing Address - Phone:843-461-0831
Mailing Address - Fax:
Practice Address - Street 1:430 ROPER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4236
Practice Address - Country:US
Practice Address - Phone:864-256-4067
Practice Address - Fax:912-200-5712
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-23-68792103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst