Provider Demographics
NPI:1962037036
Name:GHIRARDI, KRYSTAL JANE (BCBA)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:JANE
Last Name:GHIRARDI
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 1:399 UNITED RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5007
Mailing Address - Country:US
Mailing Address - Phone:860-552-9026
Mailing Address - Fax:910-493-3520
Practice Address - Street 1:399 UNITED RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5007
Practice Address - Country:US
Practice Address - Phone:860-552-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1582103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst