Provider Demographics
NPI:1871216002
Name:BANNISTER, ABBY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:
Last Name:BANNISTER
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 1:980 COUNTY ROAD 91
Mailing Address - Street 2:
Mailing Address - City:GAYLESVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35973
Mailing Address - Country:US
Mailing Address - Phone:256-484-1097
Mailing Address - Fax:
Practice Address - Street 1:316 W 10TH ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2639
Practice Address - Country:US
Practice Address - Phone:800-844-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0-22-13950103K00000X
1-23-64203103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst