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

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: July 19, 2026.

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

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
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

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

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.

Psychiatry & Neurology (Child & Adolescent Psychiatry)
126 PAVILION PKWY
FAYETTEVILLE, GA 30214
Behavior Technician
126 PAVILION PKWY
FAYETTEVILLE, GA 30214
Behavior Technician
126 PAVILION PKWY
FAYETTEVILLE, GA 30214
Behavior Technician
126 PAVILION PKWY
FAYETTEVILLE, GA 30214
Behavior Technician
126 PAVILION PKWY
FAYETTEVILLE, GA 30214
Behavior Technician
126 PAVILION PKWY
FAYETTEVILLE, GA 30214
Behavior Technician
126 PAVILION PKWY
FAYETTEVILLE, GA 30214
Behavior Technician
126 PAVILION PKWY
FAYETTEVILLE, GA 30214

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1508325135, enumerated as an "individual" on March 13, 2019.

The provider is located at 126 PAVILION PKWY FAYETTEVILLE, GA 30214 and the phone number is (770) 954-8988.

Behavior Analyst with taxonomy code 103K00000X.

The provider might be accepting Accepts: Alliant Health Plans, Inc.. Please consult your insurance carrier or call the provider to verify.