Southside Aba LLC

NPI #1134759608 in Tyrone, Georgia

Provider Information

NPI Number: 1134759608
Entity Type: Organization
Organization Name: Southside Aba LLC
Primary Specialty: Behavior Analyst
Enumeration Date: Jan 23, 2020
Last Updated: Jan 23, 2020

Practice Location

Address: 1135 SENOIA RD
City: Tyrone
State: Georgia
ZIP Code: 30290-1625
Phone: (770) 626-3044

Authorized Official

Name: CHRISTINE ELAINE MARRERO, BCBA
Title: CLINICAL DIRECTOR
Phone: (770) 707-6367

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Analyst	103K00000X	Primary

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