Basic Information
| Provider Information | |||||||||
| NPI: | 1922688845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALDEN | ||||||||
| FirstName: | MARIAH | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15193 WATERFORD DR | ||||||||
| Address2: | |||||||||
| City: | NORTH ROYALTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441335978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163041279 | ||||||||
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| Practice Location | |||||||||
| Address1: | 770 PARK CENTRE DR | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272843598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047804271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2021 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.