MS. JENNIFER MICHELLE DETHERAGE MS, BCBA
NPI 1508325135
Behavior Analyst in Fayetteville, GA

Q: What is Jennifer Detherage's NPI number?

The NPI number for Jennifer Detherage is 1508325135. It was assigned to this individual provider in the NPPES registry on March 13, 2019. The provider is also known as Jennifer Michelle Womack Ms, Bcba.

Q: What is Jennifer Detherage's specialty?

The primary specialty registered for this NPI is Behavior Analyst with taxonomy code 103K00000X.

Active since March 13, 2019

126 PAVILION PKWY, FAYETTEVILLE, GA 30214(770) 954-8988(317) 520-8200 Get Directions Write a Review

NPPES record last updated: August 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 11, 2025, Jan 30, 2023, Dec 26, 2022 and 4 more (7 updates tracked since 2019).

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About Ms. Jennifer Michelle Detherage Ms, Bcba NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. JENNIFER MICHELLE DETHERAGE MS, BCBA (NPI 1508325135) is an individual behavior analyst provider in Fayetteville, Georgia, licensed in Georgia (1-20-44609) and active in the NPI registry since March 2019. She maintains a secondary practice location in Atlanta.

NPPES Registry Identity

NPI1508325135

Entity TypeIndividualFemale

Primary Taxonomy103K00000X

Provider Legal NameMS. JENNIFER MICHELLE DETHERAGECredential: MS, BCBA

Location Address126 PAVILION PKWYFayetteville, GA 30214-4056

Mailing Address3500 Depauw Blvd Ste 3070Indianapolis, IN 46268-6135 · (855) 324-0885 · Fax (317) 520-8200

Phone(770) 954-8988

Fax(317) 520-8200

Sole ProprietorNo

Enumeration DateMarch 13, 2019

Last NPPES UpdateAugust 11, 20257 updates tracked since enumeration

NPPES CertifiedAugust 11, 2025

✔ NPI 1508325135 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyBehavior AnalystBehavioral Health & Social Service Providers

Taxonomy Code103K00000X

License✔ Licensed in GA · 1-20-44609

Definition

A behavior analyst is qualified by at least a master's degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans.

126 PAVILION PKWY, Fayetteville, GA 30214

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Other Names 1

Former Name (1)Jennifer Michelle Womack Ms, Bcba

Secondary Practice Location 1

Location 13372 Peachtree Rd NE Ste 115Atlanta, GA 30326-1963 · Phone (404) 891-1880

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc..Insurance ›

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JASMINE DIONNE

Behavior Analyst