Individual
REBECCA CORNWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, BCBA
Contact information
Practice address
101 COLISEUM BLVD, MONTGOMERY, AL 36109-2707
(334) 277-4372
Mailing address
101 COLISEUM BLVD, MONTGOMERY, AL 36109-2707
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2017-090
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-14-15309
BEHAVIOR ANALYST CERTIFICATION BOARD
—
01
—
13999037
CAQH
—
01
—
2017-090
ALABAMA BEHAVIOR ANALYST LICENSURE BOARD
AL
Enumeration date
11/15/2016
Last updated
09/16/2020
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