Individual provider · Type 1 NPI

Jennifer Michelle Detherage, MS, BCBA

Behavior Analyst · Fayetteville, GA

NPI number 1508325135 Active

Practice location

126 Pavilion Pkwy
Fayetteville, GA 30214-4056

Call (770) 954-8988 Map

Fax (317) 520-8200

Mailing address

3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135

Other practice locations

  • 3372 Peachtree Rd NE Ste 115, Atlanta, GA 30326-1963 · (404) 891-1880

Specialties and licenses

TaxonomyCodeLicense
Behavior Analyst Primary 103K00000X1-20-44609 (GA)

Behavior Analyst: 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…

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About NPI 1508325135

Jennifer Michelle Detherage, MS, BCBA's National Provider Identifier is 1508325135, issued on Mar 13, 2019. The primary taxonomy on file is Behavior Analyst (103K00000X), and the practice location is in Fayetteville, GA. The record was last updated on Aug 11, 2025.