Jennifer Michelle Detherage, MS, BCBA

Behavior Analyst · Fayetteville, GA

Individual Active NPI

NPI number 1508325135

Practice location

126 Pavilion Pkwy
Fayetteville, GA 30214-4056
Phone
(770) 954-8988
Fax
(317) 520-8200

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NPI record

NPI
1508325135
Entity type
Individual (Type 1)
Enumeration date
March 13, 2019
Last updated
August 11, 2025
Certified
August 11, 2025
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Behavior Analyst Primary 103K00000X 1-20-44609 GA

Mailing address

3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135
Phone
(855) 324-0885
Fax
(317) 520-8200

Other practice locations (1)

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

About Jennifer Detherage

Jennifer Michelle Detherage, MS, BCBA is a healthcare provider registered in the NPI registry with the primary taxonomy Behavior Analyst (code 103K00000X). The practice location is 126 Pavilion Pkwy, Fayetteville, GA 30214-4056. The NPI number 1508325135 was assigned on March 13, 2019 and the record was last updated on August 11, 2025.

Jennifer Detherage lists a license in the registry: #1-20-44609 (GA) for Behavior Analyst. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jennifer Michelle Detherage, MS, BCBA?

The NPI number is 1508325135.

What is the phone number of Jennifer Detherage?

The phone number listed for the practice location is (770) 954-8988.

Where is Jennifer Detherage located?

126 Pavilion Pkwy, Fayetteville, GA 30214-4056.

What is the taxonomy code for Jennifer Detherage?

The primary taxonomy code is 103K00000X – Behavior Analyst.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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