Individual

NPI #1831927524 in Marietta, Georgia

Provider Information

NPI Number: 1831927524
Entity Type: Organization
Organization Name: Individual
Primary Specialty: Behavior Technician
Enumeration Date: Jul 24, 2024
Last Updated: Jul 30, 2024

Practice Location

Address: 750 FRANKLIN GTWY SE APT 21B750
City: Marietta
State: Georgia
ZIP Code: 30067-7807
Phone: (334) 739-3557

Authorized Official

Name: MIRIAN BRENICK
Title: BEHAVIOR TECHNICIAN
Phone: (334) 739-3557

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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